A randomised trial of home vs hospital intravenous antibiotic therapy in adults with infectious diseases☆
Introduction
Home treatment programs are widely considered to be cost-effective, preferred by patients and families, safe, and associated with equivalent clinical outcomes to in-hospital care.1., 2., 3. Home therapy programs treating a range of conditions have been embraced by many institutions, despite lack of comparative trials assessing home and hospital outcomes. Few prospective, randomised trials comparing outcomes of home and hospital therapy have been performed.
Patient preferences and satisfaction have been cited as reasons to encourage home care, though many studies have not utilised validated tools to asses quality of life (QOL).4., 5., 6., 7. In a previous randomised trial of home and hospital therapy in adult patients with cystic fibrosis (CF), we observed larger improvements in QOL scores in patients receiving hospital therapy for acute exacerbations of their disease, compared to patients who received home therapy.8
Home intravenous (IV) therapy programmes frequently treat patients with infectious diseases who are well enough to return home early in the course of their antibiotic therapy. In order to more fully consider the effect of home therapy on QOL, and to assess the impact of a home IV service for patients with infectious diseases, clinical, cost and QOL outcomes were assessed in a prospective, randomised comparison of home and hospital IV antibiotic therapy.
Section snippets
Methods
We conducted a prospective, randomised assessment of home and hospital therapy in adult patients attending the Mater Adult and Prince Charles Hospitals in Brisbane over a two-year period. The study was approved by the Ethics Committees of both institutions.
Hospitalised, consenting adult patients (over age 14) with an infection for which IV antibiotic therapy was indicated were considered for enrolment. Patients were referred by their treating physician, and their suitability to complete their
Statistical analysis
The main study outcome was change in QOL scores. There are no precedents for the expected amount of change in SF-36 and PCHS scores over time. Home and hospital treatment groups were compared using unpaired t-tests and Mann–Whitney tests for skewed variables.
Adjustment for potential confounders and consideration of the longitudinal data on clinical, bacteriological and pathological variables used multivariate repeated measures analysis of variance models, with a generalised estimating equations
Results
One hundred and twenty-nine admissions (122 patients), were referred for consideration of home IV therapy. Eighty-two admissions (63.6%) were recruited to the trial (44 to the home group, 38 to hospital). With the final sample size, a maximum difference of 4.5% between any of the QOL parameters between groups could be detected with 80% power.
Patients included in the study were similar to those excluded with respect to gender, acuteness of admission, referral source, and outcome (Table 1).
Discussion
This study of home versus hospital administered IV antibiotics has shown that home therapy is safe and associated with clinical outcomes, including improvements in QOL, comparable to those of a hospital admission. Importantly, home therapy was not associated with a clinically important increase in duration of therapy and was significantly less costly than hospital therapy, an observation consistent with other cost analyses.7., 11. A contributing factor to the cost reductions was the policy of
Acknowledgements
We are grateful for support from Roche Pharmaceuticals and the Mater Hospitals Private Practice Fund. Statistical analysis was carried out with assistance from Dr Diana Battistutta, Lecturer in Statistics, Queensland University of Technology.
References (12)
- et al.
Home intravenous antibiotic therapy programme, 1999
J Infect
(2001) - et al.
A randomised controlled trial of the costs of hospital as compared with hospital in the home for acute medical patients
Aust N Z J Public Health
(2000) Intravenous antibiotic treatment outside the hospital: safety and health economic aspects
Rev Contemp Pharmacother
(1995)Hospital-in-the-home care: is it worth the hassle? Editorial
Med J Aust
(1998)- et al.
A randomised crossover trial of chemotherapy in the home: patient preferences and cost analysis
Med J Aust
(2000) - et al.
Hospital in the home: a randomised controlled trial
Med J Aust
(1999)
Cited by (44)
Inflammatory bowel disease patient concerns and experiences on transition to home-based infusions during the COVID-19 pandemic
2022, Research in Social and Administrative PharmacyCitation Excerpt :Wolter et al. performed a randomized trial evaluating home versus hospital intravenous antibiotics, evaluating patient perceptions using questionnaires.11 They found no difference in quality of life, safety, or tolerability, however home-based therapies reduced costs by half.11 Polinski et al. found no difference in safety or clinical outcomes, but did find an overwhelming patient preference for H-BI and savings of $2000-$3000 per course of therapy in systematic review.12
Efficacy and safety of home-based intravenous antibiotic therapy among adults: a systematic review
2022, International Journal of Antimicrobial AgentsCitation Excerpt :A summary of the findings of the included studies and the certainty of the evidence is presented in Appendix G. This systematic review assessed the effects of home intravenous antibiotic administration and identified six RCTs that compared: (i) home intravenous antibiotic therapy versus hospital intravenous antibiotic therapy (one RCT) [20]; and (ii) hospital intravenous antibiotic therapy followed by home-based intravenous antibiotic therapy versus hospital only (five RCTs) [21–25]. The RCT included in the first comparison did not assess any of the efficacy outcomes of interest in this review, only the need for hospitalisation.
The risk of overestimating cost savings from hospital-at-home schemes: A literature review
2020, International Journal of Nursing StudiesClinical management of drug-resistant bacteria in Australian hospitals: An online survey of doctors' opinions
2018, Infection, Disease and HealthInpatient versus outpatient parenteral antibiotic therapy at home for acute infections in children: a systematic review
2018, The Lancet Infectious DiseasesHospital cost of pediatric patients with complicated acute sinusitis
2016, International Journal of Pediatric Otorhinolaryngology
- ☆
The authors contributed to all stages of the project from the planning through to the analysis and writing of the paper.