Aldeyab, Mamoon A.

Abstract Introduction Virtual wards (VWs) and Hospital-at-Home (HaH) services are increasingly used in the UK to support acute care delivery. While clinical outcomes are often comparable to conventional inpatient care, the success of these models also depends on patient and carer experiences, including quality of life (QoL), satisfaction, and caregiver burden. Evidence synthesising these patient-centred outcomes within the UK context is needed to inform service implementation. Aim To systematically synthesise evidence from UK-based randomised controlled trials (RCTs) evaluating patient and carer satisfaction, QoL, and caregiver burden in VWs/HaH compared with traditional inpatient care. Methods Following PRISMA guidelines, PubMed and CINAHL databases were searched for UK-based randomised controlled trials (RCTs) (inception-October 2024) reporting QoL measures, patient/carer satisfaction, or caregiver burden, comparing VWs/HaH to traditional inpatient care for patients with acute illness. Validated tools (e.g. EQ-5D and custom surveys) were prioritised in data extraction. Risk of bias was assessed using the Cochrane RoB2 tool. Meta-analysis employed a random-effects model; heterogeneity was assessed using the I2 statistic. Results Fourteen RCTs (n = 3416 participants) met the inclusion criteria. Patient satisfaction was consistently high across studies. For example, one RCT reported very good/excellent satisfaction ratings of 91.7% for HaH compared with 88.1% for inpatient care.[1] Meta-analysis of satisfaction outcomes (five studies) showed no significant difference between groups (OR 0.67; 95% CI 0.29–1.54) with substantial heterogeneity (I2 = 78%). Carer outcomes varied; some studies found high satisfaction and no additional workload, while moderate-to-severe caregiver burden in 25% of carers was reported in one RCT.[2] QoL outcomes measured by various tools like the Euro Quality of Life EQ-5D-5L showed no clinically meaningful differences between groups. Some studies indicated better outcomes for home-treated patients in specific domains, including significantly lower depression scores (p < 0.001) and slightly higher social activity, and lower rate of select medical complications, although overall QoL remained comparable. Conclusion UK virtual health care services offer patient experiences that are comparable to traditional hospital care, with consistently high satisfaction and similar QoL outcomes. Carer experiences are more variable, highlighting a need for improved caregiver support within VW/HaH models. A key limitation of this review is the heterogeneity in the QoL and satisfaction measures used across included RCTs, which restricted the scope of quantitative synthesis. Future UK research should adopt standardised, validated outcome sets to strengthen comparability and inform evidence-based implementation.

Aim To evaluate the clinical effectiveness, cost‐effectiveness, quality of life (QoL) and patient/caregiver satisfaction associated with VWs/HaH vs . traditional inpatient care in adults with acute or post‐acute illness. Methods We conducted a systematic review and meta‐analysis of randomized controlled trials (RCTs), following PRISMA 2020 guidelines, registered with PROSPERO (CRD42024508457). Major databases were searched until October 2024. Primary outcomes were mortality, readmission, emergency attendance and length of stay. Secondary outcomes were quality of life (QoL), cost‐effectiveness, patient satisfaction and caregiver burden. Meta‐analyses employed random‐effects models; heterogeneity was assessed using the I 2 statistic. Results A total of 47 reports of RCTs (9749 patients) were included. Meta‐analyses showed no statistically significant differences in mortality over 1 to 12‐month periods (OR 0.82‐1.11, 95% CI 0.54‐1.43), readmission rates (OR 0.93‐1.16, 95% CI 0.80‐1.67) or emergency attendance rates (3‐month OR 0.86, 95% CI: 0.6–1.25). Narrative synthesis indicated VWs/HaH had higher patient satisfaction and potential cost savings. Quality of life outcomes were comparable, with some improvements in pain and emotional well‐being noted in home care settings. Conclusion VWs/HaH models demonstrated non‐inferior clinical safety and cost‐effectiveness compared to inpatient care for select adult populations. High satisfaction and comparable clinical outcomes were observed. Findings support the continued, regulated integration of virtual care into routine practice. Future research should focus on service standardization, patient/caregiver satisfaction and support and specific economic evaluations.

Abstract Objectives Healthcare institutions implement antimicrobial stewardship (AMS) programmes to optimize the use of antibiotics. The focus is often on inpatient rather than outpatient settings. We aimed to explore perceptions of AMS stakeholders on effective interventions for appropriate antibiotic use in outpatient settings, and the role of clinical pharmacists in the AMS multidisciplinary team. Methods A qualitative semi-structured interview study using thematic analysis by two researchers independently. Participants that practice AMS programmes were recruited from healthcare facilities in the United Arab Emirates (UAE). Interviews were conducted face to face or online and transcribed verbatim. Results Four themes emerged: (i) Perceived factors leading to unnecessary or inappropriate antibiotic prescribing and their impact on patients and the community; (ii) current outpatient AMS activities and perceived barriers and facilitators for their sustainability; (iii) suggested outpatient AMS strategies to be implemented in outpatient settings; and (iv) perceived future AMS implementation barriers and suggested mitigation strategies. Conclusions Several AMS interventions, together with the presence of a clinical pharmacist, may be effective in improving antibiotic use in UAE outpatient settings. Future research should investigate the most appropriate AMS strategy considering barriers and possible mitigation strategies to ensure sustainability.

Antimicrobial resistance (AMR) is a well-known global threat due to the subsequent increase in antimicrobial usage. Several antimicrobial stewardship (AMS) strategies have been implemented to curb irrational prescribing and reduce the AMR burden. However, since the beginning of the COVID-19 pandemic, it has enormously impacted the healthcare system and jeopardized public health, causing millions of deaths globally. Our semi-structured qualitative study aimed to explore the impact of COVID-19 on AMS activities in the UK hospitals. Seventeen interviews were conducted with health care professionals who were part of AMS teams (consultant medical microbiologists, infectious disease consultants, antimicrobial pharmacists). Interviews were audio-recorded and transcribed. An inductive thematic framework was adopted to analyse and create the themes. After agreement of the hierarchical framework definition, all transcripts were coded accordingly. Four main themes and 15 sub-themes were identified. These main themes were: (1) AMS activities or strategies before and during the pandemic; (2) challenges to implementing AMS activities before and during the pandemic; (3) information from public authorities on AMS during the pandemic; and (4) new AMS activities/strategies adopted during the pandemic. Staff vacancies, redeploying of AMS staff to other duties and meeting the burden related to the COVID-19 and lack of resources were the most frequently identified contributing factors to withheld AMS activities during the pandemic. However, modifications to the hybrid working environment, i.e., remote or flexible working, allowed for resumption of AMS activities including virtual ward rounds, virtual meetings and other activities. Further research needs to assess the impact of the hybrid delivery system on AMS activities.

Antimicrobial stewardship interventions are targeted efforts by healthcare organizations to optimize antimicrobial use in clinical practice. The study aimed to explore effective interventions in improving antimicrobial use in hospitals. Literature was systemically searched for interventional studies through PubMed, CINAHL, and Scopus databases that were published in the period between January 2010 to April 2022. A random-effects model was used to pool and evaluate data from eligible studies that reported antimicrobial stewardship (AMS) interventions in outpatient and inpatient settings. Pooled estimates presented as proportions and standardized mean differences. Forty-eight articles were included in this review: 32 in inpatient and 16 in outpatient settings. Seventeen interventions have been identified, and eight outcomes have been targeted. AMS interventions improved clinical, microbiological, and cost outcomes in most studies. When comparing non-intervention with intervention groups using meta-analysis, there was an insignificant reduction in length of stay (MD: −0.99; 95% CI: −2.38, 0.39) and a significant reduction in antibiotics’ days of therapy (MD: −2.73; 95% CI: −3.92, −1.54). There were noticeable reductions in readmissions, mortality rates, and antibiotic prescriptions post antimicrobial stewardship multi-disciplinary team (AMS-MDT) interventions. Studies that involved a pharmacist as part of the AMS-MDT showed more significant improvement in measured outcomes than the studies that did not involve a pharmacist.

Antimicrobial stewardship programs (ASP) are an essential strategy to combat antimicrobial resistance. This study aimed to measure the impact of an ASP multidisciplinary team (MDT) escalating intervention on improvement of clinical, microbiological, and other measured outcomes in hospitalised adult patients from medical, intensive care, and burns units. The escalating intervention reviewed the patients’ cases in the intervention group through the clinical pharmacists in the wards and escalated complex cases to ID clinical pharmacist and ID physicians when needed, while only special cases required direct infectious disease (ID) physicians review. Both non-intervention and intervention groups were each followed up for six months. The study involved a total of 3000 patients, with 1340 (45%) representing the intervention group who received a total of 5669 interventions. In the intervention group, a significant reduction in length of hospital stay (p < 0.01), readmission (p < 0.01), and mortality rates (p < 0.01) was observed. Antibiotic use of the WHO AWaRe Reserve group decreased in the intervention group (relative rate change = 0.88). Intravenous to oral antibiotic ratio in the medical ward decreased from 4.8 to 4.1. The presented ASP MDT intervention, utilizing an escalating approach, successfully improved several clinical and other measured outcomes, demonstrating the significant contribution of clinical pharmacists atimproving antibiotic use and informing antimicrobial stewardship.