Elsevier

Journal of Infection

Volume 48, Issue 3, April 2004, Pages 263-268
Journal of Infection

A randomised trial of home vs hospital intravenous antibiotic therapy in adults with infectious diseases

https://doi.org/10.1016/S0163-4453(03)00135-XGet rights and content

Abstract

Objective. Despite widespread adoption of home care services, few randomised trials have compared health outcomes in the hospital and at home. We report a prospective, randomised trial of home versus hospital therapy in adults receiving intravenous (IV) antibiotics. Our objective was to show that home care is a feasible alternative to hospitalisation over a broad range of infections, without compromise to quality of life (QOL) or clinical outcomes.

Methods. Consenting adults requiring IV antibiotics were randomised to complete therapy at home or in hospital. Short Form 36 and Perceived Health Competence Scale (PHCS) were used for assessment of QOL. Statistical analysis used unpaired t-tests, Mann–Whitney tests and ANOVA.

Results. One hundred and twenty-nine admissions were referred. Recruitment was hampered by patient preference for one therapy over another. 82 (62%) were included and randomised: 44 to home, 38 to hospital; the two groups had comparable characteristics. There were no differences in improvements in QOL and PHCS scores between the two groups after treatment. Treatment duration was median 11.5 days (range 3–57) and 11 days (range 4–126) for home and hospital groups, respectively. Home therapy costs, approximately, half that of hospital therapy. Time to readmission was longer after hospital therapy.

Conclusion. Out study showed that home IV therapy is well tolerated, is less costly, is not associated with any major disadvantage to QOL or clinical outcomes compared to hospital therapy, and is an appropriate treatment option for selected patients.

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)

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