Study Concludes At-home Antibiotic Therapy for Cystic Fibrosis No Riskier than at Hospital
Many patients would generally perform to have their treatments done at home than in a hospital; it's a familiar place, the patient can be more comfortable, travel isn’t necessary. It was assumed, however, that intravenous antibiotic treatment for cystic fibrosis patients would not be as safe at home as if it were administered in a hospital.
Researchers set out to confirm or debunk this statement, and they found that having the treatment done at home was generally just as safe as in a hospital.
Advantages of At-Home Treatment for Cystic Fibrosis Patients
On top of being generally more comfortable for the patient and their families, at-home treatment has additional benefits. It becomes less costly, as families no longer have to pay for hospital fees or transport. More importantly, cystic fibrosis patients are constantly at a risk of airway infections. At a hospital, this risk is significantly heightened because they are exposed to many hospital patients who have infections, making their home a safer place to receive treatment. Quality of life is also seen to significantly improve among cystic fibrosis patients when receiving at-home care instead of being admitted into a hospital. As shown in various studies, increasing quality of life assists in other aspects of the disorder itself as well.
Patients were asked to list reasons they preferred at-home treatment and the most common responses were less interruption to education and career, reduced earning losses and traveling expenses, improved quality of life, tastier food, more facilities to exercise, less disruption to sleep, more convenient timing of drug administration, reduced risk of cross infection, and lack of hospital beds.
Downsides of At-Home Treatment
Although the benefits listed by the patients are compelling reasons to look to at-home treatment, many health-care professionals have their own concerns. The most common are reduced medical input, reduced input from physiotherapists and dietitians, possible lack of compliance with the IV treatment, lack of rest, and reliance on patients to diagnose these complications.
These worries are substantial, and gave reason to why researchers wanted to conduct a study to see whether the safety was actually decreased or not. While the new study has shown that there is a comparable level of safety, and that at-home treatment is no riskier, these concerns of medical professionals should be kept in mind to ensure a safe treatment.
Feasibility of At-Home Treatment
Hospitals and cystic fibrosis centers possess many skilled professionals as well as top-notch equipment, resulting in an air of professionalism that may seem difficult to duplicate within one's home. However, it is possible to produce the same level of care. In fact, if staff and patients are trained properly, and financial support is planned, home care is not difficult to manage, as long as the patient is compliant. Because the same level of care can be administered, with these few necessary preparations, it is a feasible alternative.
The Review
Researchers from the Royal Children's Hospital and the Murdoch Children's Research Institute in Australia compiled and analyzed preexisting studies to see if there was any merit to hospital treatment being safer or more effective than at-home treatment. They were largely inspired by decreasing the burden on children who are patients of cystic fibrosis.
The researchers' review spanned 19 studies involving children who were patients of various infections. These included infections capable of causing acute cystic fibrosis exacerbations, which was of particular interest to the researchers.
In the studies, there was variation among the administration of the at-home treatment. In certain studies, nurses were responsible for the treatment whereas in others, nurses would visit the patient's home to govern the care. Although not as common, physiotherapists were also sometimes a part of the at-home care of cystic fibrosis patients.
Within the studies, doctors decided to treat children at home largely on the preferences of both the patients and their families, especially if they were living far from the care facility they would have to travel to. However, doctors did analyze how severe the infection was before they allowed treatment to be done in the home, and ensured that the family would be diligent in administering the treatment as to not put the patient in danger.
For more information, you can find the study "Inpatient versus outpatient parenteral antibiotic therapy at home for acute infections in children: a systematic review" in the journal The Lancet Infectious Diseases.
Results
The results of the study showed that the children receiving at-home treatment tended to be treated longer than those in the hospital, but the level of care was not significantly different. Safety proved to be identical in both forms of treatment, at home or in the hospital.
However, there were differences between at-home or in hospital treatment found by the researchers other than the levels of safety. The study showed that patients and their families showed to be significantly happier when they were allowed to stay at home instead of traveling to the hospital. Costs also drastically decreased for these families by 30 to 75 percent. With such a substantial decrease in costs, the quality of life surrounding the patient is able to increase, with more money available for other uses.
Naomi Katz, who is a co-author of the study, explained, “children do better psychologically at home, they get better faster, they are less at risk of hospital-acquired infections, and dynamics are improved for the whole family.”
Importance of the Study
Co-author Penelope A. Bryant is a professor and pediatric representative of the National Hospital-in-the-Home Society. As a strong proponent of at-home treatment, especially for children, she explains, "many children in hospital are on IV [intravenous] antibiotics. Most parents would prefer their children be at home if it is safe to do so. This study gives the evidence to support doctors to treat their patients with IV antibiotics at home while keeping them under daily medical review. If we can get children safely home even one day earlier, that's a good thing."
Moving Forward
While this study offered interesting insights, how will it change the treatment of children suffering from CF? Well, co-authors are hopeful that it will change the necessity of patients to have to go to the hospital for procedures that could be done at home.
Bryant explains, "it is likely that there are many patients currently being treated in hospital who could be treated at home, both in Australia and worldwide, and it’s not just IV antibiotics – other traditional hospital interventions could also be given outside the hospital environment. To see just how far-reaching into improving healthcare this type of program could be, further research is needed.”
Both co-authors, Bryant and Katz, agree that a clinical trial will be necessary in order to verify the findings they put forward in their review. Their ultimate goal is to prevent certain patients to have to be admitted to the hospital at all, but this cannot be reached without further solidification of their findings. However, if a clinical trial is put forward and verified, it is possible that the number of patients, especially children, needing to receive care at the hospital may decline, resulting in further comfort and cost savings for patients and their families.
References
https://www.ncbi.nlm.nih.gov/pubmed/7744185
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714563/
