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Published on: August 30, 2018
Inequitable access to an outpatient parenteral antimicrobial therapy service: linked cross-sectional study
Colin Sumpter1, Clark D Russell2, Claire Mackintosh3
1Department of Public Health and Policy, NHS Lothian, Waverley Gate, Edinburgh, UK. c.sumpter@nhs.net.
Insights
Outpatient Parenteral Antimicrobial Therapy (OPAT) access is inequitable. Patients from affluent areas and men were more likely to receive OPAT, highlighting disparities in this growing healthcare approach.
Area of Science:
- Healthcare access and equity
- Antimicrobial stewardship
- Public health policy
Background:
- Outpatient Parenteral Antimicrobial Therapy (OPAT) is a growing model for intravenous antimicrobial administration.
- Expansion of ambulatory care models like OPAT risks exacerbating healthcare inequities.
- Previous studies and anecdotal evidence suggest gender and social group disparities in OPAT access.
Purpose of the Study:
- To evaluate the equity of Outpatient Parenteral Antimicrobial Therapy (OPAT) provision across gender and socioeconomic status in a tertiary care setting.
- To identify potential disparities in access to OPAT services.
- To inform strategies for equitable healthcare delivery in ambulatory care.
Main Methods:
- Retrospective cross-sectional study linking inpatient cellulitis episodes with OPAT referral data over seven years (2012-2017).
- Inclusion of 6295 admissions from 4944 individuals with a primary diagnosis of cellulitis.
- Analysis of demographics, comorbidities, length of stay, distance to OPAT unit, and Scottish Index of Multiple Deprivation (SIMD) using logistic regression.
Main Results:
- Significant inequities in OPAT access were identified.
- Patients from the most affluent SIMD quintile were over twice as likely to receive OPAT referrals compared to the most deprived (aOR 2.08).
- Females were nearly a third less likely to receive OPAT referrals than males (aOR 0.69).
Conclusions:
- OPAT services and other ambulatory care programs must routinely assess and address equity gaps.
- Proactive service planning is crucial to prevent the development of inequitable systems.
- Ensuring equitable access to OPAT benefits is a critical responsibility to avoid disadvantaging vulnerable populations.
Study Aim:
To assess whether Outpatient Parenteral Antimicrobial Therapy (OPAT) is provided equitably across gender and social groups in a tertiary care setting.
Background:
OPAT is a widely used and growing approach in high income countries to early discharge or admission avoidance for patients requiring intravenous antimicrobials. There is however a risk that equitable access to healthcare could be eroded unintentionally by expansion of outpatient or ambulatory approaches such as this. Anecdotal evidence in our service, and from published studies, have identified a gender and social group equity gap in outpatient services.
Methods:
Service data on inpatient cellulitis episodes over a seven-year period were matched to OPAT referral data to create a retrospective cross-sectional linked dataset. All individuals admitted from 2012 to 2017 inclusive for a primary diagnosis of cellulitis were included: 6295 admissions of 4944 individuals. Demographics, number of co-morbidities, length of hospital stay, number of admissions, distance from OPAT unit and Scottish Index of Multiple Deprivation (SIMD; as a metric of deprivation) were recorded. Adjusted odds of a referral to OPAT across SIMD quintiles and for females compared to males were calculated using multiple logistic regression.
Results:
Inequitable access to OPAT was identified. Deprivation was negatively associated with likelihood of OPAT referral. Inpatients from the most affluent SIMD quintile were more than twice as likely to have received an OPAT referral compared to those resident in the most deprived quintile (adjusted OR 2.08, 95% CI: 1.60-2.71, p < 0.0001). Women were almost a third less likely to receive an OPAT referral than men (adjusted OR 0.69, 95% CI: 0.58 to 0.82, p < 0.001). Results were adjusted for age, number of co-morbidities, admissions, length of stay, distance from nearest OPAT unit, time since first admission, deprivation and gender.
Conclusions:
OPAT services and other ambulatory care programmes should routinely evaluate the equity of their service provision and consider how they can reduce any identified imbalance. It is a critical responsibility of service planning to ensure an inequitable system does not develop, with those least able to access ambulatory care dispossessed of the associated benefits.
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