Evaluating the Patient Experience and Preferences Regarding Elastomeric Infusers for Continuous Antibiotic Delivery in Hospital in the Home Services.

Between 2015 - 2050, over 10,000 Australians are projected to die due to Antimicrobial resistance (AMR) related infections (The Review on Antimicrobial Resistance, 2016). Consequently, more careful practices need to be employed when administering antibiotics to prevent further exacerbation of this growing issue. A key strategy in mitigating this problem is ensuring patients adhere to and complete their antibiotic regimens. Monash Health offers a HITH service that allows patients to continue their care (including intravenous antibiotic infusions) in their homes rather than in the hospital. This service has been shown to improve patient satisfaction, outcome and reduce overall hospital associated costs (Tase et al., 2022). As such, the Monash Health HITH program administered 1736 days of therapy for one of the most common AMR infections (ESBL E. coli) in 2018 (is there a more recent stat for this?).

Due to the rapidly rising demand for HITH services, (in the treatment against AMR infection?), various avenues are being explored to improve HITH effectiveness, capacity and scalability. Many ‘new to market’ antimicrobials are being developed, and commercial infusion device suppliers are actively seeking novel technologies to expand the range of antibiotic therapies that can be delivered. 

Currently, patients who require long term antibiotic treatment are offered an option to receive continuous infusion (CI) via an elastomeric infusor by the HITH service. To facilitate CI, patients require a peripherally inserted central catheter (PICC) line, which is inserted under local anaesthetic 15 minute procedure. After the PICC line is inserted, patients are placed on a continuous 24-hour antibiotic infusion cycle (via elastomeric infuser through PICC line?), which repeats daily. A nurse visits the patient's home once a day to replace the infuser, and patients also have a weekly hospital visit to review their treatment progress. This regimen continues for as long as eight weeks. Despite the convenience offered by this option, CI can also place strain on a patient's overall wellbeing and potentially restrict their daily activities. Moreover, there is currently a lack of formal research examining HITH patient perspectives on carrying their infuser and the potential issues relating to its use.

Primary users of HITH medical devices (elastomeric infusers) are likely to be from a non-medical background. Despite the rise in admissions to HITH, usability issues continue to be a significant problem within medical devices, leading to reduced effectiveness, decreased patient satisfaction and increased user error within home settings (Tase, et.al, 2022).  By improving the experience or usability of the device, patients will have improved treatment results (Bitkina, Kim, & Park, 2020). Therefore, understanding the patient's experience and their receptiveness to treatment is crucial to improving the effectiveness of CI antibiotic delivery in newly developed devices. 

This research aims to assess the effectiveness of management practices, and preferences of patients using elastomeric infusers for CI antibiotic delivery within HITH services. The study will evaluate the overall usability of the current elastomeric infuser, determining its efficacy in patient care, and identifying areas where the user experience can be enhanced. The results of this study will provide valuable insights to inform the creation of more specialised and efficient alternatives, whether in approach or device.

A detailed survey focussing on the current use of the antibiotic infusor and the patients experience. Questions will focus on the current treatment plan and patients preference relating to specifications of the device including the wearability, perceived limitations or impacts, and ease of use.  

We will collect survey data both retrospectively, and from patients currently undergoing HITH treatment at Monash Health Centres. The consenting patients will be surveyed during their weekly HITH appointment, by Monash related staff members.

The information gathered from the data will be de-identified and retained on Monash Health servers for the duration of the study with limited access (restricted to study investigators only).

Data will be collected from 20-40 HITH patients and descriptive statistics will be performed to summarise the findings.

Risks/ ethical issues are negligible. 

1. We aim to publish the findings in a high-quality peer-reviewed journal.

2. We aim to develop an intuitive and patient-centric solution that will allow for the effective administration of temperature-sensitive antibiotics, such as Meropenem, through Continuous Infusion in HITH services.