Certain conditions, such as infection of the heart valves or a bone infection, require long-term antibiotic use, usually for six or more weeks. All too often, uninsured patients end up staying in the hospital to receive the full course of this treatment.
In a study published online at PLOS, doctors at Parkland Hospital in Dallas County, Texas investigated whether uninsured patients given proper instruction on self-administration of medication involving a multidisciplinary team, would have outcomes as good as their counterparts with insurance. The results were very encouraging.
The study investigators enrolled 1,168 patients, with 944 receiving self-administration of antibiotics and 224 who would receive their antibiotics by one of the other options. When 30-day readmission rates were examined, readmission was 47 percent lower for patients in the self-administration group, and the death rate at one year did not significantly differ between the groups.
If this finding is confirmed with further similar studies, that would represent great news for healthcare, as self-administering intravenous, or IV, antibiotics would be an acceptable form of treatment saving countless days of unnecessary in-patient stays.
The lead author of the study, Dr. Kavita Bhavan, Assistant Professor of Internal Medicine at UT Southwestern, aptly states, Requiring these patients to be hospitalized for several weeks means loss of personal freedom for the patients and a delay in activities of daily living, such as returning to work and caring for children at home. This practice also can lead to a tremendous cost for public hospitals, taking up beds that could go to patients who require more intensive care.
To expand on Dr. Bhavan's statement, by eliminating these unnecessary, prolonged hospital stays, patients are also at a greatly reduced risk for developing other hospital-acquired infections, which are often multi-drug resistant. Simply being confined to a hospital makes patients feel more sick than being in the comfort of their own homes.
To put things in perspective, in 2009 the cost of a diagnosis of ineffective heart valves, otherwise known as endocarditis, generated on average a whopping total of $122,204 per case. As the authors of the study indicate, most of the intensive diagnostic procedures are performed within the first few hospital days. The rest of the in-patient hospital stay is simply to receive IV antibiotics.
Outpatient parenteral antimicrobial therapy (OPAT) allows patients to be treated outside hospitals in infusion centers, nursing homes, patients own homes with visits from skilled nurses, or at home with self-administration of therapy. The least common mode is self-administration. Data are lacking to support whether self-administration is therapeutically on par with the other three methods.
To say there is a tremendous amount of waste in healthcare is an understatement. Healthcare dollars are misallocated in many instances. More research needs to be directed toward delivering safe and effective treatments for patients while keeping cost-control in mind.
This study is a perfect example of how a doctor was able to recognize a glaring problem in healthcare, and offer an elegant and simple solution.