Patient-Reported Outcomes for Understanding of Instructions and Success Rates in the 65+ Age Group Receiving Home-Based Outpatient Parenteral Antimicrobial Therapy (OPAT)
Authors: Haines Danell , Sullivan Connie , Charron Jennifer 
Published: February 2025

Background: Patients in the 65+ age group and those receiving outpatient parenteral antimicrobial therapy (OPAT) in the home setting are increasing. There is a void in research that investigates OPAT satisfaction and outcomes in the 65+ age group. To better serve the home infusion needs of this population, an investigation of the patient’s OPAT success rate and understanding of home infusion instructions is needed. The purpose of this study is to determine if differences exist between OPAT patients aged 18-64 and 65+ in their understanding of home infusion instructions and their therapy success rate.

Methodology: Study data was obtained from the National Home Infusion Foundation (NHIF) database, including data from the NHIF-validated patient satisfaction survey and status at discharge benchmarking project. Five questions about the patient’s understanding of instructions are part of the satisfaction survey. Status at discharge data was used to determine OPAT success since therapy completed, unplanned hospitalizations, and adverse drug reaction (ADR) data were collected. Data analysis included determining if a significant difference (p= ≤ .05) exists between the 18-64 and 65+ age groups.

Results: Forty-five home infusion providers submitted 3,262 OPAT patient satisfaction surveys, while 15 submitted 4,360 OPAT status at discharge patient cases to the NHIF database. The composite score for the 5 Yes/No questions that assessed the patient’s understanding of instructions was 98.45%. The only significant difference detected by the Fisher’s Exact Test between the 2 age groups was the response to the question about the patients’ understanding of how to wash their hands. “Therapy completed” status at discharge from home infusion accounted for 90.11% of the OPAT 65+ year old patients. The rate of ADRs in the 65+ patient population was 0.25%, while the 18-64 age group rate was higher at 0.42%. Conversely, the unplanned hospitalization rate was higher in the 65+ age group (4.79%) than in the 18-64 age group (3.28%). The results of the Chi-Square analysis indicate a significant difference (p=.027) between the 2 age groups and status at discharge.

Discussion: The patient-reported data collected by NHIF reveals a significant difference (p=.009) between the 18-64 age group and older adult (65+) in their understanding of how to wash their hands with the 18-64 age group having a better understanding of the task. When calculated as a composite score, 98.45% of older adults report understanding the instructions provided on how to wash their hands, store medications, care for the IV catheter, administer the IV therapy, and use the equipment. Significant differences exist (p=.027) in the status at discharge between adults 65+ and those 18-64. Older adults are less likely to have an ADR but are more likely to be discharged from home infusion due to an unplanned hospitalization. This difference can be attributed to the higher clinical acuity and co-morbidities associated with increased age. Even so, 90.11% of the patients age 65+ successfully completed OPAT therapy.

Conclusions: An aging population in the U.S. is driving increased use of home-based OPAT in adults 65+. This study confirms that most older adults understand the instructions related to performing home infusion tasks. While over 90% of older adults in this study were successful in completing their home-based OPAT therapy and had a lower rate of ADRs, there was a significant difference in patients 65+ when compared to patients 18-64 years of age in the reasons for discontinuing home-based OPAT, including higher rates of unplanned hospitalization.

Keywords: Home infusion, outpatient parenteral antimicrobial therapy (OPAT), 65+, patient instructions, adverse drug reaction (ADR), therapy complete, unplanned hospitalization