Factors promoting or hindering self-administered outpatient parenteral antimicrobial therapy: a systematic literature...

Although self-administered outpatient parenteral antimicrobial therapy (S-OPAT) has several advantages over nurse-administered therapy, it remains underused. A comprehensive understanding of the determinants of S-OPAT-the factors that hinder or promote its use-is essential to improve the quality of care and increase uptake.

This systematic review aimed to identify and synthesize determinants influencing the entire S-OPAT patient care pathway, from the offer of S-OPAT to its acceptance, training and performance, considering the perspectives of healthcare professionals, patients and their caregivers.

We systematically searched PubMed, Embase, PsycINFO and CINAHL for original articles published between January 2000 and July 2024 on determinants influencing decision-making and experiences regarding S-OPAT and other self-administered intravenous therapies. Determinants were thematically analysed to construct overarching themes. This review was registered in PROSPERO (CRD42022311294).

In 23 studies reporting behavioural determinants (11 on S-OPAT), a total of 238 determinants were identified to influence the offer, acceptance, training and performance of self-administration. A limited number of studies explored determinants influencing the offer of S-OPAT and the caregiver's perspective. The overarching themes included stakeholders' cognitions or affect, collaboration and communication, context, resources and skills and capabilities, which influenced all steps in the patient care pathway. Many determinants were identified regarding cognitions or affect and collaboration and communication, stressing the importance of considering stakeholders' opinions on self-administration and improving transmural collaboration.

This review revealed key behavioural determinants shaping the success of S-OPAT. Targeting these factors can overcome implementation barriers and improve access, caregiver engagement and quality of care.