Ambulatory antibiotic infusion devices: extending the spectrum of outpatient therapies

Article Abstract:

Intravenous administration of fluids and drugs was begun about 40 years ago, with significant improvement of patient response to treatment. The technique was originally used in hospitals, as invasive procedures may lead to complications such as infection. However, intravenous antibiotic therapy was eventually given on an outpatient basis, especially when long-term treatment was needed. This has proven to be safe, effective, and cost-effective. However, a number of patients are ineligible for treatment, whether due to handicaps, lack of family support, or requirement for frequent therapy. Computerized infusion pumps have become available, chiefly for hospital use, and provide more reliable and accurate therapy. The use of these pumps in an outpatient setting was evaluated with 98 patients (56 male), who were ineligible for regular minibag intravenous therapy due reasons such as age, inappropriate home environment, needle phobias, or residence in a nursing home without continuous registered nursing care. Of these patients, 86 percent used the pumps at home. Intravenous antibiotic therapy was given for an average of 18 days. Infections of wounds, bone, heart lining, soft tissues, and pneumonia were the reasons for treatment. Twenty different organisms were identified from patients' tissues, and 12 antibiotics were used. Twelve patients developed phlebitis (vein inflammation) and had to have the site of the intravenous line altered or where switch to oral antibiotics. Access to veins failed in six cases. Three patients had pain during antibiotic infusion. Pumps failed twice; ear or kidney toxicity each developed once; and one patient developed cellulitis (inflammation of connective tissue such as skin, bone, or cartilage) after refusing to have the intravenous site changed. The cost of antibiotic infusion was less than that of the intravenous minibag method. Infections were completely resolved in 80 percent of cases, while recurrent infections developed in 8.3 percent of cases. The study indicates that patients who previously could not receive intravenous antibiotics as outpatients may be able to do so with infusion pumps in a safe, effective, and cost-saving manner. (Consumer Summary produced by Reliance Medical Information, Inc.)

Antibiotics, Dosage and administration

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High tech comes home

Article Abstract:

Intravenous administration of fluids and medications first began in the 1950s. Because this invasive procedure can have severe complications such as infection, it has been given only in hospitals for many years. In some cases, long-term administration of antibiotics or other drugs is necessary, and an assortment of devices have been developed to meet this need. However, this has also meant prolonged hospitalization, a costly event. Intravenous administration of antibiotics was adapted for outpatient use in the 1970s and has been demonstrated to be effective, safe, and less costly. It has also been well accepted by doctors, patients, and most insurance companies. In most cases, outpatient administration involved a gravity drip from a minibag, either administered by the patient or by a relative or caregiver. A programmable, computerized infusion pump has improved the accuracy and reliability of intravenous medicine delivery. A recent study of outpatient use of the infusion pump, published in the November 1991 issue of The American Journal of Medicine, indicates that such use is technically feasible and safe. Questions remain to be answered, including how frequently the pumps will be used; how important is constant infusion by the pump compared with intermittent treatment by minibag; and if the overall cure rates differ. Further studies of the two systems are needed. However, it appears that the infusion pump may be a safe alternative for outpatients. Hopefully, its use will be reimbursed by insurance companies and Medicare. (Consumer Summary produced by Reliance Medical Information, Inc.)

Editorial

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Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome

Article Abstract:

Many symptoms of patients seen in an outpatient practice are often poorly understood. This paper investigated the incidence, diagnostic findings and clinical outcome of 14 common symptoms. The authors reviewed the records of one thousand patients over a three-year period. The following information was noted for each symptom: patient characteristic, duration, suspected cause, evaluation, treatment and outcome of the symptoms. Cost estimates for making the diagnostic evaluation were calculated. A total of 567 new complaints were noted with 38 percent of the patients reporting at least one new symptom. Although diagnostic testing was performed in more than two-thirds of the cases, a proven cause could be found in only 16 percent. Only 55 percent of the cases were treated, often ineffectively. In cases where a clinical outcome was noted, 53 percent improved. Three favorable factors were associated with a good outcome: organic (physically identifiable) cause, symptom lasting less than four months, and a history of two or fewer symptoms. The cost of discovering a diagnosis was high: headache ($7,778), back pain ($7,263). The authors conclude that the classification, evaluation and management of common symptoms need to be refined. Diagnosis emphasizing organic causes may be inadequate.

Economic aspects, Medical care, Cost of, Health care costs, Patient monitoring, Physiologic monitoring

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