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Efficiency of a self-administered outpatient parenteral antimicrobial therapy (s-opat) for infective endocarditis within the context of a shortened hospital admission based on hospital at home program.

Efficiency of a self-administered outpatient parenteral antimicrobial therapy (s-opat) for infective endocarditis within the context of a shortened hospital admission based on hospital at home program.
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Pajarón M, Lisa M, Fernández-Miera MF, Dueñas JC, Allende I, Arnaiz AM, Sanroma-Mendizábal P, De Berrazueta JR, Fariñas MC, ,


Pajarón M, Lisa M, Fernández-Miera MF, Dueñas JC, Allende I, Arnaiz AM, Sanroma-Mendizábal P, De Berrazueta JR, Fariñas MC, , (click to view)

Pajarón M, Lisa M, Fernández-Miera MF, Dueñas JC, Allende I, Arnaiz AM, Sanroma-Mendizábal P, De Berrazueta JR, Fariñas MC, ,

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Hospital practice (1995) 2017 11 10() 1-7 doi 10.1080/21548331.2017.1398588
Abstract
OBJECTIVE
This study aimed to evaluate the efficiency of treatment of infectious endocarditis (IE) via Self-administered Outpatient Parenteral Antimicrobial Therapy (S-OPAT) supported by a shortening hospital admission program in a hospitalization-at-home unit (HAH), including a short review of the literature.

METHODS
Ambispective cohort study of 57 episodes of IE in 54 patients treated in an HAH unit between 1988 and 2014 who receive S-OPAT after prior intra-hospital clinical stabilization. Characteristics of each episode of IE, safety and efficiency of the care model, were analyzed.

RESULTS
Forty-three (76%) patients were males with a median age of 61 years (SD = 16.5). A total of 37 (65%) episodes affected the native valve (42% the aortic valve). In 75%, a micro-organism was isolated, of which 88% were Gram-positive bacteria. No deaths occurred during HAH program, clinical complications appeared in 30% of episodes, only 6 patients were re-admitted to hospital although no patient died. In the 12 months’ follow-up 3 cases had a recurrence. The average cost of a day stay in HAH was €174 while in traditional cardiology hospitalization was €1100. The total average cost of treatment of each episode of IE managed entirely in hospital was calculated as €54,723. Application of the S-OPAT model based on HAH meant a cost reduction of 32.72%.

CONCLUSIONS
In suitably selected patients, treatment of IE based on S-OPAT supported by a shortening hospital admission care program by means of referral to a HAH unit is a safe and efficient care model which entails a significant cost saving for the public healthcare system.

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