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台灣在宅醫療學會 秘書處 敬上

為慶祝台灣在宅急症照護（Acute Care at Home, ACAH）推行一週年，並共同擘劃居家靜脈抗生素治療（Outpatient Parenteral Antimicrobial Therapy, OPAT）的未來藍圖，由社團法人台灣在宅醫療學會與奇美醫療財團法人奇美醫院聯合主辦的「在宅急症照護一週年：ACAH 與 OPAT 的對話」活動，於2025年7月2日（星期三）下午1時至5時50分在台北晶華酒店3樓B廳隆重舉行。本次活動匯聚海內外重量級專家，包括英國帝國理工學院Mark Gilchrist教授，以及台灣政府及臨床醫療及藥學界代表，共同探討面對超高齡社會挑戰下，台灣醫療照護政策的創新與實務經驗，旨在提升醫療韌性、優化資源分配，並確保病人用藥安全與品質。

本次盛會的召開，正值台灣醫療體系因應超高齡社會帶來的嚴峻挑戰之際。預計2025年台灣將邁入超高齡社會，65歲以上人口比例已超過20%且持續快速增加。隨之而來的是慢性病及癌症盛行率上升，需長期醫療照護的需求激增。加上新科技加速醫療支出成長，以及少子女化、高齡化結構衝擊健保收入，使得健保財務長期面臨壓力。面對這些挑戰，台灣醫療體系迫切需要更有效率及節制的資源分配機制，以確保醫療品質，並實現以人為中心、全生命歷程的照護服務。在此背景下，在宅急症照護（ACAH）與門診靜脈抗生素治療（OPAT）的推動，成為優化醫療服務、緩解醫院壓力的關鍵策略。

在宅急症照護（ACAH）一週年：卓越成效與願景

自2024年7月1日啟動的在宅急症照護試辦計畫（ACAH），至今已屆滿一週年。這項服務旨在提供「住院的替代服務」，增加醫療體系韌性，並減少居家失能或機構住民因急症往返醫院的負擔。奇美醫院湯宏仁副院長在會中分享了醫院推動OPAT與在宅住院（HaH）結合的經驗。奇美醫院在推動在宅急症照護與門診靜脈抗生素治療（OPAT）方面展現了豐富的實踐經驗。自2025年2月設立OPAT收治流程以來，截至同年5月底已服務39位病人。這些病人主要來自門診（62%）,急診（23%)及早期出院（15%)。顯示OPAT有效分流了住院需求。收案對象以泌尿道感染（54%）為大宗，且半數病人年齡超過65歲，主要由感染科（49%）和泌尿科（20%）轉介。

奇美醫院的OPAT治療成效良好，有6位病人因發燒不適或軟組織感染部位疼痛需轉住院，且病人普遍對不用住院感到滿意。此外，醫院積極導入彈性輸注幫浦（Infusor），這項技術有助於減少護理師居家照護時間、增加抗生素選擇性並降低抗藥性風險。儘管在推動過程中，仍面臨靜脈炎或漏針風險、假日注射不便及人力配置等挑戰，奇美醫院仍規劃未來將持續推動居家OPAT（H-OPAT）服務，並優化資訊系統與AI輔助，以持續提升醫療效率與病人照護品質。

根據健保署最新數據，截至2025年5月31日，ACAH計畫已核定174個團隊、789家醫療院所參與。在約近3000例的收案個案中，75歲以上的高齡長者佔70%，且78%的個案巴氏量表分數小於20分（完全依賴），顯示主要服務對象為行動不便、失能者。

ACAH計畫的成效斐然。收案適應症以尿路感染（49%）最多，其次為肺炎（37%）和軟組織感染（14%）。平均照護天數顯著低於全國平均，例如肺炎平均7.9天，尿路感染和軟組織感染均為6.2天，整體平均僅6.9天，遠低於全國平均住院天數12天。這項計畫推算每日可減少至少106床的醫院佔床數，有效緩解了急診壅塞及病床壓力。在經濟效益方面，ACAH個案平均醫療費用約為3萬點，相較於相同條件下的住院個案（約6.9萬點），有效節省了健保費用。此外，個案結案後3天或14天內再轉往急診的比例僅5%，證明了計畫在確保照護品質方面的成功。

門診靜脈抗生素治療（OPAT）新制上路：緩解急診壅塞，提升醫療效率

為進一步緩解急診壅塞與病床壓力，健保署積極推動「門診靜脈抗生素治療方案（OPAT）」，並預計於2025年8月1日正式上路。健保署黃珮珊參議指出，這項新制將允許過去需要住院接受靜脈抗生素治療但病情穩定、行動力良好的患者，在門診進行治療。適用的感染症包括肺炎、尿路感染、軟組織感染、骨髓炎、心內膜炎及術後感染等。

OPAT將採按日計費的「包裹給付」方式，每日一次治療處置費為1031點，每日兩次以上為1234點，並另給予個案管理費500點。每個療程以5天為限。健保署估計，每年約20萬感染症病患住院，若其中10%（約2萬人）能轉為門診治療，將顯著減輕住院壓力，並為患者帶來更大的生活時間彈性。雖然門診處置費預計增加約1億點健保支出，但相較於住院治療可節省約3億點，預期能為健保節省整體支出。

國際經驗與全球展望：藥物安定性與抗藥性挑戰

英國帝國理工學院Mark Gilchrist教授在會議中分享了英國OPAT的發展經驗與全球合作的視野。英國的OPAT服務自1995年發展至今，已服務大量患者，並建立了標準化的指導方針。然而，OPAT在國際上面臨的重要挑戰之一是藥物安定性數據的缺乏。許多窄譜抗生素缺乏經過驗證和發表的安定性數據，限制了其在非住院環境下的廣泛使用。

Gilchrist教授強調，患者安全取決於藥物安定性證據，以確保達到藥物動力學/藥效學（PK/PD）目標，並了解降解產物以避免潛在毒性。英國感染化學治療學會（BSAC）自2009年起投入資金，制定標準化檢測藥物安定性方法，並推動開放實驗數據，以支持推廣OPAT服務中抗感染藥物和設備的應用。他指出，全球監管機構對於安定性測試指南存在差異，除了英國NHS的Yellow Cover Document（YCD）外，大多數主要監管機構沒有針對門診環境的具體指南，這帶來了溫度、物理安定性、降解產物評估等方面的挑戰和不確定性。

面對日益嚴峻的**抗微生物藥物抗藥性（AMR）**問題，OPAT的推動也扮演了重要角色。透過持續輸注等方式，可以更好地遵守抗菌藥物管理原則，使用窄譜藥物，並最大程度地發揮OPAT的效益。Gilchrist教授呼籲，需要建立一個全球性的實踐社群，以生成和分享普遍可接受的數據，促進穩定性測試框架的全球協調。他同時提及了新型給藥裝置（如預充雙腔裝置DCDs）和治療藥物監測（TDM）的潛力，以進一步提升OPAT的效率和安全性。

居家醫師視角：在宅急症照護24小時連續輸注抗生素之經驗分享

台灣在宅醫療學會理事陳蕙雅醫師，也在會議中分享了台中社區居家醫療照護的寶貴經驗。案例主角是位近80歲、臥床失智、多重管路（尿管、氣切、鼻胃管）的男性，因肺炎及尿路感染面臨住院治療需求。面對其複雜病況及反覆住院史，團隊決定在住宿式長照機構中提供「在宅急症照護」。初期雖嘗試口服及間歇性靜脈注射抗生素，但考量護理人力與頻繁給藥的挑戰，團隊創新導入彈性輸注幫浦（EIP/Infusor）進行24小時連續輸注抗生素治療。此舉不僅成功在社區完成急性期治療，顯著減少住院次數，更凸顯了藥品安定性、流速控制及無菌配置在居家環境下的重要考量。此案例充分展現了醫師、護理師、藥師、呼吸治療師等多專業團隊的緊密合作，並經家庭會議共同決策 的效益，為台灣推動在宅急症照護提供了寶貴的實踐經驗。

社區藥師視角：OPAT實務挑戰與藥品安定性管理

在「社區藥局在宅急症抗生素連續輸注實務與挑戰」議題中，美術藥局總藥師游佩雯分享了社區藥局在團隊執行抗生素連續輸注方面的寶貴經驗及所面臨的挑戰。她指出，社區藥局在抗生素針劑的採購上常遭遇藥廠不願出貨等阻礙，且藥物操作在社區環境中難度高，例如護理師需「從家到家」移動，交通成本大，與醫院「從病房到病房」的模式截然不同。

游藥師透過一個80歲男性多重管路、吸入性肺炎個案的實際案例，詳細說明了從經驗性治療到精準治療的抗生素選擇、劑量調整及給藥方式優化過程。該個案從最初的口服抗生素治療無效轉為靜脈注射，並最終因護理師人力限制，改採彈性輸注幫浦（Elastomeric Infusion Pump, EIP）進行24小時連續輸注。

此案例突顯了藥品安定性管理在社區居家治療中的關鍵挑戰。游藥師強調，「室溫安定性不等於臨床實務安定性」。在台灣室內溫度常高於25°C的情況下，藥品安定性可能受影響，文獻中常基於25°C的安定性數據與實際臨床使用環境存在落差。她建議，台灣應重新建立本土的抗生素安定性數據，透過HPLC等檢測，以確保病人用藥安全及藥效。此外，EIP的流速受溫度影響大，流速控制器需妥善貼合病人皮膚，且藥品配製環境的無菌性與配製後的儲存（冷藏後回溫）都需嚴格把關。目前，抗生素連續輸注液調製尚未納入健保特殊輸注處方藥品服務費，這也影響了EIP在社區的推廣與臨床執行。

未來展望與持續努力

「在宅急症照護一週年：ACAH 與 OPAT 的對話」活動的成功舉辦，不僅回顧了過去一年ACAH的卓越成效，更為未來OPAT的發展指明了方向。展望未來，台灣在宅醫療學會與奇美醫院將持續推動更多居家OPAT（H-OPAT）模式，並引進Infuser等新設備，提升居家靜脈抗生素治療的便利性與多樣性。同時，將持續擴大ACAH/OPAT的適應症，並參考國際經驗優化政策。

面對醫療人力不足（特別是護理人力）的挑戰，Infuser的應用可望減少護理人員的負擔，提升人力效率。此外，加強病人教育與追蹤、建立標準化操作流程（SOP）、提升團隊訓練與信心、以及推動資訊系統與AI輔助，將是確保OPAT品質與病人安全的關鍵。透過多功能團隊的合作和政府的政策支持，台灣的醫療照護體系正朝向更有效率、以病人為中心、更具韌性的方向邁進，共同為超高齡社會的健康福祉努力。

主辦單位：社團法人台灣在宅醫療學會 

合辦單位：奇美醫療財團法人奇美醫院

Immediate Release: In-Home News Flash

One-Year Anniversary of Taiwan’s Acute Care at Home: A Dialogue on ACAH and OPAT Ushers in a New Chapter for Healthcare in a Super-Aged Society

[Location] Taipei, [July 2, 2025]

To celebrate the one-year anniversary of the implementation of Taiwan’s Acute Care at Home (ACAH) initiative and to jointly map out the future blueprint for Outpatient Parenteral Antimicrobial Therapy (OPAT), the Taiwan Society of Home Health Care and Chi Mei Medical Center hosted “One-Year Anniversary of Acute Care at Home: A Dialogue on ACAH and OPAT.” This event took place on Wednesday, July 2, 2025, and brought together government officials and clinical experts from Taiwan and abroad, including Professor Mark Gilchrist from Imperial College London. Discussions focused on innovative healthcare policies and practical experiences addressing the challenges of a super-aged society, aiming to enhance healthcare resilience, optimize resource allocation, and ensure medication safety and quality.

This grand event coincided with the critical challenges posed to Taiwan’s healthcare system by the super-aged society. By 2025, Taiwan is projected to enter the super-aged society stage, with over 20% of the proportion aged 65 and above and is rapidly increasing. This trend brings a surge in the prevalence of chronic diseases and cancer, significantly increasing the demand for long-term care. Coupled with the rapid growth of medical expenses driven by new technologies, as well as the financial pressures on the National Health Insurance (NHI) system caused by low birth rates and an aging population, Taiwan’s healthcare system urgently requires more efficient and restrained mechanisms for resource allocation to ensure healthcare quality and achieve patient-centered, lifelong care services. Against this backdrop, the promotion of Acute Care at Home (ACAH) and Outpatient Parenteral Antimicrobial Therapy (OPAT) has become a key strategy for optimizing healthcare services and alleviating hospital pressures.

One Year of Acute Care at Home (ACAH): Achievements and Vision

The pilot program for Acute Care at Home (ACAH), launched on July 1, 2024, has now reached its one-year milestone. This service aims to provide an “alternative to hospitalization,” enhancing the resilience of the healthcare system and reducing the burden of frequent hospital visits for acute care among homebound or institutionalized residents. Dr. Hung-Jen Tang, Vice Superintendent of Chi Mei Medical Center, shared the hospital’s experience in integrating OPAT with Hospital at Home (HaH). Chi Mei has demonstrated extensive practical experience in promoting Acute Care at Home and OPAT. Since the establishment of OPAT admission procedures in February 2025, the hospital has served 39 patients by the end of May 2025. The majority of these patients were referred from outpatient clinics (62%) and emergency departments (23%), indicating that OPAT effectively diverted hospitalization needs. Most cases involved urinary tract infections (54%), with half of the patients aged over 65, primarily referred by the departments of infectious diseases (49%) and urology (20%).

Chi Meis OPAT treatment outcomes have been favorable, with only 15% of patients requiring hospitalization due to fever or discomfort, and patients generally expressing satisfaction with avoiding hospital stays. Additionally, the hospital has actively introduced elastomeric infusion pumps (Infusors), which help reduce nursing time for home care, increase the range of antibiotic options, and lower the risk of antibiotic resistance. Despite it still faces challenges such as the risks of phlebitis or needle dislodgement, inconvenience of injections on holidays, and staffing issues, Chi Mei plans to continue promoting Home OPAT (H-OPAT) services and optimize information systems and AI assistance to further enhance medical efficiency and patient care quality.

According to the latest data from the NHI Administration, as of May 31, 2025, the ACAH program has approved 174 teams and 789 medical institutions to participate. Among nearly 3,000 cases serviced, 70% involved elderly patients aged 75 and above, and 78% had Barthel Index scores below 20 (completely dependent), indicating that the primary service recipients are individuals with mobility impairments or disabilities.

The ACAH program has achieved remarkable results. The most common indications for admission were urinary tract infections (49%), followed by pneumonia (37%) and soft tissue infections (14%). The average length of care was significantly lower than the national average, with pneumonia averaging 7.9 days, urinary tract infections and soft tissue infections both averaging 6.2 days, and an overall average of only 6.9 days, far below the national average hospital stay of 12 days. This program is estimated to reduce hospital bed occupancy by at least 106 beds daily, effectively alleviating emergency department congestion and hospital bed pressures. Economically, the average medical cost per ACAH case was approximately 30,000 points, compared to 69,000 points for similar inpatient cases, significantly saving NHI expenditures. Additionally, the proportion of cases returning to the emergency department within three or 14 days after discharge was only 5%, demonstrating the program’s success in ensuring care quality.

New OPAT Initiative: Alleviating Emergency Congestion and Enhancing Medical Efficiency

To further alleviate emergency department congestion and hospital bed pressures, the NHI Administration is actively promoting the “Outpatient Parenteral Antimicrobial Therapy (OPAT) Program,” scheduled to launch on August 1, 2025. Deputy Director Huang, Pei-Shan of the NHI Administration stated that this new initiative will allow patients who previously required hospitalization for intravenous antibiotic treatment but are clinically stable and mobile to receive treatment in outpatient settings. Applicable infections include pneumonia, urinary tract infections, soft tissue infections, osteomyelitis, endocarditis, and postoperative infections etc.

The OPAT program will adopt a “bundled payment” system, with a daily treatment fee of 1,031 points for once-daily treatments and 1,234 points for treatments twice or more per day, along with a case management fee of 500 points. Each treatment course will be limited to five days. The NHI Administration estimates that approximately 200,000 infection cases require hospitalization annually, and if 10% (about 20,000 patients) can transition to outpatient treatment, it will significantly reduce hospitalization pressures and provide patients with greater flexibility in their daily lives. While outpatient treatment fees are expected to increase by approximately 100 million points annually, this is expected to save about 300 million points compared to inpatient treatment, leading to overall savings for the NHI system.

International Experience and Global Outlook: Drug Stability and Antimicrobial Resistance Challenges

Professor Mark Gilchrist from Imperial College London shared the development of OPAT in the UK and its global collaborative perspective. Since its inception in 1995, the UK’s OPAT services have served numerous patients and established standardized guidelines. However, one of the major international challenges for OPAT is the lack of validated drug stability data. Many narrow-spectrum antibiotics lack published stability data, limiting their widespread use in non-hospital settings.

Professor Gilchrist emphasized that patient safety depends on evidence of drug stability to ensure pharmacokinetic/pharmacodynamic (PK/PD) targets are met and to understand degradation products to avoid potential toxicity. The British Society for Antimicrobial Chemotherapy (BSAC) has been funding efforts since 2009 to develop standardized methods for testing drug stability and promoting open experimental data to support the application of anti-microbial and devices in OPAT services. He noted that global regulatory agencies differ in their guidelines for stability testing. Except for the UK NHS’s Yellow Cover Document (YCD), most major regulatory agencies lack specific guidelines for outpatient settings, posing challenges and uncertainties regarding temperature, physical stability, and degradation product assessments.

Amid the growing crisis of antimicrobial resistance (AMR), OPAT also plays a crucial role. Continuous infusion methods can better adhere to antimicrobial stewardship principles, use narrow-spectrum drugs, and maximize the benefits of OPAT. Professor Gilchrist called for the establishment of a global practice community to generate and share universally acceptable data, facilitating the global coordination of stability testing frameworks. He also highlighted the potential of new delivery devices (e.g., prefilled dual-chamber devices, DCDs) and therapeutic drug monitoring (TDM) to further enhance OPAT’s efficiency and safety.

Perspectives from Home Physicians: Experience with 24-Hour Continuous Antibiotic Infusion in Acute Home Care

Dr. Hui-Ya Chen, a board director of the Taiwan Society of Home Health Care, shared valuable experiences in Taichung communities. She shared the experience of a case involved a nearly 80-year-old bedridden male with dementia and multiple tubes (urinary catheter, tracheostomy, nasogastric tube) who required hospitalization for pneumonia and urinary tract infections. Given his complex condition and history of repeated hospitalizations, the team decided to provide “acute care at home” in a residential long-term care facility. Initially attempting oral and intermittent intravenous antibiotics, the team innovatively introduced flexible infusion pumps (EIP/Infusors) for 24-hour continuous antibiotic infusion due to nursing workload and frequent dosing challenges. This approach successfully completed acute-phase treatment in the community, significantly reducing hospitalizations. The case highlighted the importance of drug stability, flow rate control, and aseptic preparation in home environments. It also demonstrated the benefits of close collaboration among physicians, Nurses, pharmacists, respiratory therapists, and family decision-making.

Perspectives from Community Pharmacists: Practical Challenges of OPAT and Drug Stability Management

In the session “Practical Challenges of Continuous Antibiotic Infusion in Community Pharmacies,” Pharmacist You, Pei-Wen of Meishu Pharmacy shared her experiences and challenges in executing continuous antibiotic infusion in a community setting. She emphasized obstacles such as supplier’ reluctance to provide injectable antibiotics, and the operational difficulties in community settings she faced. Moreover, unlike the “from ward-to-ward” model in hospitals, nurses must travel “from house to house,” incurring high transportation costs.

Through sharing the experience of caring a case involving an 80-year-old male with aspiration pneumonia, she detailed the process of optimizing antibiotic selection, dosage adjustments, and administration methods from empirical to precision therapy. The case transitioned from oral antibiotics to intravenous injections and eventually to 24-hour continuous infusion using an Elastomeric Infusion Pump (EIP) due to nursing staffing constraints.

This case underscored the critical challenges of drug stability management in community home treatment. Pharmacist You stressed that “room temperature stability does not equate to clinical practice stability.” In Taiwan, where indoor temperatures often exceed 25°C, drug stability may be affected, and the stability data based on 25°C in literature may not align with real-world clinical settings. She recommended establishing localized antibiotic stability data in Taiwan using techniques like HPLC to ensure medication safety and efficacy. Moreover, EIP flow rates are highly temperature-dependent, requiring proper adherence of flow controllers to patients’ skin, and strict control of aseptic preparation environments and storage (e.g., refrigeration and warming post-preparation). Currently, the preparation of continuous antibiotic infusion solutions is not covered under NHI’s special infusion prescription service fees, which affects the promotion and clinical implementation of EIP in the community.

Future Outlook and Continued Efforts

The successful hosting of the “One-Year Anniversary of ACAH: A Dialogue on ACAH and OPAT” not only reviewed the outstanding achievements of ACAH over the past year but also pointed the way forward for OPAT’s development. Looking ahead, the Taiwan Society of Home Health Care and Chi Mei Medical Ceneter will continue promoting more Home OPAT (H-OPAT) models, introducing new equipment like Infusers to enhance the convenience and diversity of home intravenous antibiotic treatments. At the same time, they will expand the indications for ACAH/OPAT and optimize policies by referencing international experiences.

In addressing the challenge of healthcare workforce shortages, particularly nursing staff, the application of Infusers is expected to reduce nursing workload and improve workforce efficiency. Additionally, strengthening patient education and follow-up, establishing standardized operating procedures (SOPs), enhancing team training and confidence, and advancing information systems and AI assistance will be critical to ensuring OPAT quality and patient safety. Through the collaboration of multidisciplinary teams and government policy support, Taiwan’s healthcare system is moving toward greater efficiency, patient-centered care, and resilience, striving together for the health and well-being of a super-aged society.

Organizers: Taiwan Society of Home Health Care 

Co-Organizers: Chi Mei Medical Center