Research shows that intravenous treatment has financial and quality of life consequences for parents and caregivers

When they treat patients, doctors sometimes forget the impact of their decisions on a world they never see: the patient's family life. In the case of some serious infections in children, oral antimicrobial drugs are just as effective at treating these ailments in the home as conventional intravenous medications. However, according to a new study conducted by researchers at the University of Utah Health, medications to be taken by mouth are a great way to preserve the quality of life of parents.

Not only are the costs of oral therapy significantly lower than those of intravenous therapy (US $ 7 vs. US $ 65 per day), but parents and caregivers spend significantly less time on intravenous therapy. administer (6 to 90 minutes). In addition, children undergoing oral therapy take eight days less at school or daycare (5 versus 13.5 days) and parents are absent less from their working hours (30 vs. 60 hours). ). The results published recently online in Hospital pediatrics.

"The benefits of using oral treatment instead of OPAT (outpatient antimicrobial treatment) are evident when one thinks about what is involved for patients and caregivers," he said. says Adam Hersh, MD, author and badociate professor of pediatric pediatrician at the Children's Primary Hospital. "But many clinicians have been stuck in the use of intravenous therapy without recognizing that the overall burden for caregivers of a child is extremely high."

When children are hospitalized with serious infections – such as pneumonia, bone infections, meningitis, or blood infections -, standard care typically advocates the invasive procedure of catheter placement so that parents can administer medications by the way. intravenous once returned home. As catheters require meticulous care and carry risks of infection and coagulation, parents must play the role of home-based nurse when injecting medications, changing dressing and purging infusion lines. In comparison, giving children antimicrobial drugs in the form of tablets or liquids is simpler.

It is becoming increasingly clear that for some conditions traditionally treated with OPAT, cure rates are just as high with oral therapy. The University of Health investigators designed this study on the premise that understanding the cost differences and burden of both therapies for informal caregivers could influence health care provider recommendations.

The first author Nathan Krah, Ph.D., Hersh and his colleagues interviewed caregivers for almost three years. Two hundred and twelve participants answered questions about the fact that they were comfortable with the administration of the child's therapy and about the costs involved. Of these participants, 42% administered oral treatment at home and 58% received OPAT. From the survey data, the researchers calculated a quality of life score using a standard measure called the quality of life inventory of children.

The difference in scores between the two groups helped to better understand the lives of patients and their families. Caregivers who administered intravenous medications scored nine points lower in quality of life than those who administered oral medications to their children (77.8 vs. 68.9).

"When patients are at home, the time that caregivers need to invest in the OPAT regimen takes something else," said Hersh. "They lose the equivalent of a full work week during an average treatment – an apprenticeship that has really opened my eyes."

Krah's research is the first to demonstrate the financial impact and quality of life of this therapy on parents and educators.

Given that this study was conducted in a single infectious disease clinic, it remains to be seen whether the same conclusions hold for parents in similar situations across the country. In addition, it is not yet clear how differences in education, medical history or social support networks of a caregiver can influence his or her experience.

Whatever the easiest therapy, there are situations where intravenous home therapy is still needed. With the new information, parents will have a better idea of ​​what awaits them. "Now doctors can set their expectations," says Krah. "If the patient comes home with the OPAT, clinicians can help him anticipate the necessary costs and time, including missed work or school days. We can tell them that it can be a very big business. "