（盐湖城）——在治疗病人时, doctors sometimes overlook how their decisions impact a world they never see: a patient's home life. 在一些严重感染儿童的情况下, oral antimicrobial drugs are just as good at treating these ailments at home as the standard, 静脉注射药物. 但根据研究人员领导的一项新研究 大发娱乐, by-mouth medications excel in the important measure of preserving parents' quality of life.
Not only are costs for oral therapy significantly lower than intravenous therapy ($7 vs $65 each day) but parents and caregivers spend significantly less time administering it (6 vs 90 minutes). 进一步, children on oral therapy miss eight fewer days of school or daycare (5 vs 13.5 days) and parents take less time off of work (30 vs 60 hours). 研究结果最近在网上发表 医院儿科.
"The advantages of using oral therapy instead of OPAT (outpatient parenteral antimicrobial therapy) are obvious when you think about what's involved for patients and caregivers,亚当·赫什说, MD, senior author and associate professor of Pediatrics at U of U Health and a pediatrician at Primary Children's Hospital. "But many clinicians have stuck with using intravenous therapy without recognizing that the overall burden on a child's caregivers is extremely high."
When children are hospitalized with serious infections – such as pneumonia, 骨感染, meningitis or bloodstream infections – standard care has usually called for the invasive procedure of placing a catheter so that parents can administer medications intravenously (OPAT) once they return home. Because the catheters require meticulous care and carry risks for infection and clotting, parents must double as home nurses as they infuse medications, 换敷料，冲洗静脉导管. By comparison, giving children antimicrobial medication by pill or liquid is simpler.
There is increasing evidence that for some conditions traditionally treated with OPAT, 口腔治疗的治愈率同样高. U of U Health investigators designed this study with the idea that understanding the differences in cost and burden of the two therapies on caregivers could influence health care providers' recommendations.
第一作者Nathan Krah博士.D., Hersh and colleagues surveyed caregivers over a nearly three-year period. Two hundred and twelve participants answered questions about their comfort with administering the child's therapy and out-of-pocket costs. 在这些参与者中, 42 percent gave patients oral therapy at home and 58 percent administered OPAT. 根据调查数据, the investigators calculated a quality of life score using a standard measure called the Pediatric Quality of Life Inventory.
The difference in scores between the two groups yielded new insight into the lives of patients and their families. Caregivers who administered medications intravenously scored nine points lower on quality of life measures than those who gave children oral medication (77.8 vs 68.9).
“当病人在家的时候, time that caregivers need to invest in the OPAT therapy regimen takes away from other things,赫什说。. "They lose the equivalent of an entire work week over the course of an average treatment course. 这让我大开眼界."
Krah's research is the first to demonstrate the financial and quality-of-life toll of this therapy on parents and caregivers.
Because this study was carried out in a single infectious disease clinic, it remains to be determined whether the same findings hold true for parents in similar situations across the country. 进一步, it is not yet understood how differences in a caregiver's education, medical background or social support networks may influence their experience.
不管哪种疗法更容易, there are situations where intravenous therapy at home will still be necessary. With the new information, parents will have a better idea of what lies ahead. “现在，医生可以设定期望，”Krah说. “如果病人带着OPAT回家, clinicians can help them anticipate what will be involved in terms of costs and time required, 包括旷工或旷课. We can tell them that this can be a really big undertaking."
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"Economic Burden of Home Antimicrobial Therapy: OPAT Versus Oral Therapy" was published in 医院儿科. 除了克拉和赫什, 合著者是Tyler Bardsley, 理查德·纳尔逊, 来自uu Health的Lawanda Esquibel说, Mark Crosby from Intermountain Healthcare and Carrie Byington from Texas A&米大学
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大发娱乐 provides leading-edge and compassionate medicine for a referral area that encompasses 10% of the U.S.包括爱达荷州、怀俄明州、蒙大拿州和内华达州的大部分地区. A hub for health sciences research and education in the region, U of U Health touts a $356 million research enterprise and trains the majority of Utah's physicians and more than 1,250 health care providers each year at its Schools of Medicine and Dentistry and Colleges of Nursing, 药剂学与卫生. With more than 20,000 employees, the system includes 12 community clinics and four hospitals. For nine straight years, U of U Health has ranked among the top 10 U.S. academic medical centers in the rigorous Vizient Quality and Accountability Study, 包括达到. 2010年和2016年各1次.