10 Figure 1 illustrates the distribution of the episodes of care within WA. Thirty-seven (42%) episodes of care were provided in areas designated as remote or very remote according to the Australian Standard Geographical Classification. Median travel distance (return) saved per telemedicine appointment was 576 km (IQR 402–1430). Diabetes was present in 31 patients (37%) and the median Charlson Comorbidity Index was 2 (IQR 1–4). The median patient age was 56 years (IQR 43–66). Eight patients (10%) were indigenous Australian. Resultsĭuring the study period, 88 OPAT telemedicine episodes of care were delivered to 83 patients. The Royal Perth Hospital Human Research Committee granted ethics approval for this study (HREC REG 15–022). 9 Drug-related adverse events including rash, eosinophilia, hepatitis, myositis, cytopenias and acute kidney injury were as defined previously. Failure occurred when there was: (i) progression or no improvement despite OPAT (ii) unplanned re-admission related to OPAT (iii) requirement for surgical intervention or (iv) death.
Improvement was defined as completion of the planned duration of OPAT followed by oral antibiotics. The hardware used was the Scopia desktop with a Logitech C170 webcam and Polycom HDX 70 systems.Ĭure was defined as completion of OPAT with resolution of infection and no requirement for ongoing oral antibiotics. Videoconferences were held at a bandwidth of 384 kilobits to 1 megabit per second via internet protocol. All patients had weekly laboratory monitoring performed and attended (accompanied by local nursing staff) a routine weekly videoconference for review by an ID consultant or fellow, utilizing government funded telemedicine facilities operating in hospitals throughout regional WA. Antibiotic administration and other nursing requirements were performed by local nursing services however, medical governance was retained by an ID physician. Antibiotics were given once daily by slow injection or continuous infusion using a 24 h elastomeric device. 1 All antibiotics were administered via a peripherally inserted central catheter with first dose given prior to discharge. Only antibiotics with stability data were used. All telemedicine-supported OPAT procedures were in accordance with pre-existing, local written policies. Patients were identified from our existing OPAT database, with information then extracted from patient medical records.īefore acceptance on to the programme every patient had ID physician and OPAT nurse reviews to assess patient suitability. We retrospectively reviewed adult patients who received OPAT via telemedicine at Royal Perth Hospital between April 2011 and February 2015. In this study, we report our novel experience combining OPAT with telemedicine to manage a large cohort of complex patients receiving OPAT for acute ID in a geographically vast location. One-third of Australians live outside of major cities, 8 posing unique challenges providing equity of care when OPAT is planned.
Western Australia (WA) encompasses 2645615 km 2, which is approximately four times the size of France.
4 Although the IDSA Practice Guidelines for OPAT 1 endorses telemedicine and a recent European technical report recognized telemedicine ‘plays a major role for the development of medicine and healthcare delivery in Europe’, 5 surveys of OPAT practices in Europe, North America and Asia demonstrate limited uptake. 4 Telemedicine has been successfully used in ID to manage chronic infections such as TB, HIV and viral hepatitis however, its application to acute infections has been incompletely evaluated.
Telemedicine refers to the use of telecommunication and information technologies to provide clinical healthcare to distant or isolated individuals. 1–3 However, as most infectious diseases (ID) physicians practice within tertiary centres, ID-led OPAT services often use a hospital-based model of care, where patients remain in proximity of hospital clinics or infusion centres to facilitate clinical review. OPAT has been adopted worldwide and, when accompanied by appropriate patient selection and medical governance, it is safe, efficacious, cost-effective and improves patient productivity. Outpatient parenteral antimicrobial therapy (OPAT) substitutes for inpatient care by enabling intravenous antimicrobial therapy to be administered within patients’ homes.