Barriers and facilitators for the implementation and expansion of outpatient parenteral antimicrobial therapy: a systematic review

BackgroundOutpatient parenteral antimicrobial therapy (OPAT) program has been expanding in recent years and serves as a viable solution in reducing the shortage of hospital beds. However, the wider implementation of OPAT faces numerous challenges. This review aimed to assess implementation barriers and facilitators of OPAT services.MethodsStudies describing barriers and facilitators to OPAT service were retrieved from PubMed, Scopus, MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Science Proceedings, International Pharmaceutical Abstracts, and PsycINFO. All types of study designs published in the English language were included. Studies that did not mention any barrier or facilitator, did not differentiate OPAT and inpatient, focused on specific antimicrobials or diseases, and made no distinction between parenteral and other treatments were excluded. Qualitative analysis was performed using the "best-fit" framework approach and the Consolidated Framework for Implementation Research (CFIR). The review was PROSPERO registered (CRD42023441083).ResultsA total of 8761 studies were screened for eligibility and 147 studies were included. Problems in patient selection, lack of awareness, poor communication and coordination, lack of support, lack of structured service, and inappropriate prescriptions were identified. OPAT provides safe, effective, and efficient treatment while maintaining patients' privacy and comfort, less daily life disruption, and reducing the risk of infection. Satisfaction and preference for OPAT were very high. Initiatives in strengthening OPAT such as antimicrobial stewardship (AMS) and telemedicine are beneficial.ConclusionChallenges and facilitators to OPAT service were identified among patients, health professionals, OPAT service providers, and health care administrators. Understanding them is crucial to designing targeted initiatives for successful OPAT service implementation.