Malaysia’s Hospital-at-Home Antibiotic Service Wins Overwhelming Patient Approval

For decades, patients with serious infections faced a stark choice: weeks confined to a hospital bed hooked to an intravenous drip, or an early discharge that risked undertreatment. A quiet revolution in Malaysian public hospitals is now challenging that trade-off, and a new nationwide survey suggests patients are embracing it with remarkable enthusiasm. Outpatient parenteral antimicrobial therapy, known as OPAT, allows people to receive intravenous antibiotics outside the hospital walls, either by visiting a clinic or by managing the infusion themselves at home. A cross-sectional study published in BMC Health Services Research has now measured, for the first time at this scale in Malaysia, how satisfied patients actually are with the service, and the answer is emphatic: more than ninety percent report a positive treatment experience.

The research, led by Ahmad Iman Ammer Azman and Audrey Huili Lim of the Institute for Clinical Research at Malaysia’s National Institutes of Health, together with colleagues from Hospital Sungai Buloh and Hospital Selayang, surveyed 224 OPAT patients aged 18 and older across 13 Malaysian public hospitals. Data collection ran from October 2024 to December 2025 using a structured questionnaire administered through the REDCap electronic data capture platform. The mean age of participants was 44.0 years, with a standard deviation of 17.1, meaning the sample spanned young adults through to the elderly. The study was funded by a grant from the Ministry of Health Malaysia and registered in the National Medical Research Register, with ethics approval from the Medical Research and Ethics Committee.

Technically, the satisfaction instrument was built around four domains: patient confidence in the therapy, tolerability of the antibiotics, quality of the OPAT facilities, and the competence of the OPAT team. Scores ranged from 0.00 to 5.00, with categories running from not satisfied at the bottom of the scale to highly satisfied at 5.00. The statistical rigour of the instrument was assessed using established psychometric indices, including the average variance extracted, the comparative fit index, the Tucker-Lewis index, the root mean square error of approximation, and the standardised root mean squared residual, measures that together confirm whether the questionnaire reliably captures what it claims to measure. This validation matters because patient satisfaction scores are only useful if the tool generating them is trustworthy.

The headline result is striking. Of the 224 patients, 119, or 53.1 percent, were highly satisfied, and a further 98, or 43.8 percent, were satisfied, meaning 96.9 percent of participants reported a positive treatment experience overall. Confidence in the efficacy of OPAT was high among 166 patients, or 74.1 percent of the sample. Nearly all patients, 211 individuals or 94.2 percent, said they were happy with the service, and an overwhelming 219 patients, or 97.8 percent, said they would recommend it to others. In the language of health services research, a recommendation rate approaching ninety-eight percent is close to a ceiling result for any medical service.

Drilling into the four satisfaction domains reveals where the service excels. Antibiotic tolerability, meaning how well patients physically cope with the medications, earned the extremely satisfied rating from 149 patients, or 66.5 percent. Team performance was even stronger, with 190 patients, or 84.8 percent, extremely satisfied with the OPAT team. Facility quality drew extremely satisfied ratings from 176 patients, or 78.6 percent. Among patients who interacted with the OPAT team, 78.6 percent were extremely satisfied with communication, a figure that underscores how central clear dialogue between clinicians and patients is to the perceived quality of the service.

The clinical logic behind OPAT is worth unpacking. Intravenous antibiotics remain essential for deep-seated infections such as bone and joint infections, endocarditis, and complicated soft tissue infections, where oral drugs alone cannot achieve adequate tissue concentrations. Traditionally, delivering these drugs required admission for the entire course, often several weeks. OPAT breaks that dependency by allowing patients to receive the same intravenous therapy through a peripherally inserted central catheter, or PICC line, while living at home. Patients may attend a hospital clinic for each dose, or in self-administration models, they and their caregivers are trained to connect the infusion themselves. The approach reduces exposure to hospital-associated infections, frees scarce beds, and restores patients to their families and workplaces, all while maintaining the pharmacological intensity of treatment.

Malaysia has progressively implemented OPAT services in its public hospital system, but until now, evidence on patient satisfaction with the service remained scarce. This gap is significant for health services planning, because OPAT is only sustainable if patients accept and adhere to it. The new study addresses that evidence deficit directly and finds that the Malaysian model is well accepted and well tolerated, with notable strengths in antibiotic tolerability, team competency, and facility quality. The findings align with a growing international literature, including a 2024 mixed-methods study on patient perspectives of OPAT and a 2026 analysis of Türkiye’s unstructured OPAT system, both of which highlight the importance of structured, patient-centred service design.

The study is not without its caveats, and the authors report them candidly. Although overall satisfaction was high, a minor subset of six patients, or 2.7 percent, experienced issues during treatment. The survey design was cross-sectional, capturing a snapshot in time rather than tracking satisfaction longitudinally, and it relied on self-reported data from patients willing to participate. The sample of 224, while substantial for a nationwide service evaluation, represents a fraction of the total OPAT population, and satisfaction scores can be influenced by response bias, with happier patients potentially more likely to complete questionnaires. Nevertheless, the consistency of results across all four domains, and the near-universal willingness to recommend the service, suggests the positive findings are robust rather than artefactual.

What does this mean for the future of infection care in Malaysia and beyond? The results provide health administrators with concrete evidence that OPAT is not merely clinically effective but genuinely popular with the people who use it. High satisfaction with team performance and communication suggests the training and staffing models in Malaysian hospitals are working, while strong tolerability ratings indicate the antibiotics themselves are being managed skilfully. The identification of the small subset of patients who experienced issues offers a starting point for targeted improvement, and the validated satisfaction instrument now exists as a reusable tool for ongoing monitoring. As antimicrobial stewardship becomes ever more critical in the age of rising resistance, services that deliver potent therapy efficiently while keeping patients out of hospital beds will only grow in importance, and Malaysia’s OPAT programme now has the patient endorsement to justify its expansion.

For patients, the message is simple and empowering: serious infection no longer necessarily means serious confinement. The Malaysian experience demonstrates that a well-organised outpatient antibiotic service can achieve satisfaction levels that few hospital-based interventions ever reach, with 97.8 percent of patients willing to recommend it. For clinicians and policymakers watching from other countries, the study offers a template for how to evaluate such services rigorously, using validated instruments, multi-hospital sampling, and transparent reporting of both strengths and weaknesses. The era of hospital-at-home antimicrobial therapy is advancing, and in Malaysia, patients have delivered their verdict with near-unanimous clarity.

Subject of Research: Evaluation of the outpatient parenteral antimicrobial therapy (OPAT) service in Malaysia: a cross-sectional study of patient satisfaction

Article Title: Evaluation of the outpatient parenteral antimicrobial therapy (OPAT) service in Malaysia: a cross-sectional study of patient satisfaction

Article References: Azman, A. I. A., Ab Rahman, N., Misnan, N. A., Marizan Nor, A. N., Tok, P. S. K., & Lim, A. H. (2026). Evaluation of the outpatient parenteral antimicrobial therapy (OPAT) service in Malaysia: a cross-sectional study of patient satisfaction. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15828-w

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15828-w

Keywords: Evaluation, outpatient, parenteral, antimicrobial, therapy, OPAT, service, Malaysia, cross-sectional, patient, satisfaction, scientific research