Close Patient Follow-up Among Patients Receiving Outpatient Parenteral Antimicrobial Therapy

2019 ◽  
Vol 70 (1) ◽  
pp. 67-74 ◽  
Author(s):  
Danielle L Palms ◽  
Jesse T Jacob
Keyword(s):  
Logistic Regression ◽  
Antimicrobial Therapy ◽  
Care Transitions ◽  
Clinic Visit ◽  
Outpatient Setting ◽  
Multivariate Logistic Regression Model ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Charlson Comorbidity Score ◽  
Pathogen Diagnosis

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) programs allow patients to receive intravenous treatment in the outpatient setting. We developed a predictive model of 30-day readmission among hospitalized patients discharged on OPAT from 2 academic medical centers with a dedicated OPAT clinic for management. Methods A retrospective medical records review was performed and logistic regression was used to assess OPAT and other outpatient clinic follow-up in conjunction with age, sex, pathogen, diagnosis, discharge medication, planned length of therapy, and Charlson comorbidity score. We hypothesized that at least 1 follow-up visit at the Emory OPAT clinic would reduce the risk for hospital readmission within 30 days. Results Among 755 patients, 137 (18%) were readmitted within 30 days. Most patients (73%) received outpatient follow-up care at Emory Healthcare within 30 days of discharge or prior to readmission, including 52% of patients visiting the OPAT clinic. The multivariate logistic regression model indicated that a follow-up OPAT clinic visit was associated with lower readmission compared to those who had no follow-up visit (odds ratio, 0.10 [95% confidence interval, .06–.17]) after adjusting for infection with enterococci, Charlson score, discharge location, and county of residence. Conclusions These results can inform potential interventions to prevent readmissions through OPAT clinic follow-up and to further assess factors associated with successful care transitions from the inpatient to outpatient setting.

scholarly journals 623. Self-Administered Outpatient Parenteral Antimicrobial Therapy (S-OPAT) in Uninsured Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S371-S371
Author(s):  
Yasir Hamad ◽  
Jaspur Min ◽  
Yvonne Burnett
Keyword(s):  
Antimicrobial Therapy ◽  
Adverse Drug Events ◽  
Hospital Length ◽  
Clinic Visit ◽  
Hospital Length Of Stay ◽  
Uninsured Patients ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Joint Infections ◽  
Insured Patients ◽  
Hospital Days

Abstract Background Uninsured patients requiring long-term intravenous (IV) antimicrobials do not have access to outpatient parenteral antimicrobial therapy (OPAT) and often remain hospitalized for the duration of their treatment, transition to inferior oral antimicrobials, or leave against medical advice. A hospital-supported self-administered OPAT (S-OPAT) program was piloted in uninsured patients to decrease hospital length of stay and improve access to care. Methods Uninsured adult patients requiring IV antimicrobials were enrolled in an S-OPAT pilot study from July 2019 to April 2020. Patients with drug use history or documented non-adherence were excluded. S-OPAT patients attended weekly clinic visits for blood draws, dressing changes, and medication supply. The measured outcomes were hospital days saved, and potential income generated by earlier discharges. The latter was calculated by multiplying the number of hospital days saved by the daily charge for a hospital bed to insured patients. Results Seventeen patients were enrolled in S-OPAT, 14 (82%) were males, 8 (47%) were black, and the mean age was 39 years. The most common indication for OPAT was bone and joint infections in 12 (71%), and most commonly used antibiotic was ceftriaxone in 12 (71%) patients (Table). Early discontinuation occurred in 3 (17%) patients due to clinic visit non-adherence resulted in 2 (12%) and adverse drug events in 1 (6%). Only one (6%) patient had unplanned hospital readmission during OPAT. Transition to S-OPAT resulted in 533 hospital days avoided, and a net saving of approximately $900,000. Conclusion S-OPAT model is safe and can enhance care for uninsured patients while optimizing health-system resources. Table Disclosures All Authors: No reported disclosures

scholarly journals Factors affecting the rates of adherence to surveillance recommendations for incidental pancreatic cystic lesions in a large urban safety net hospital

2020 ◽  
Vol 7 (1) ◽  
pp. e000430
Author(s):  
Andrew Canakis ◽  
Asaf Maoz ◽  
Jaroslaw N Tkacz ◽  
Christopher Huang
Keyword(s):  
Primary Care ◽  
Logistic Regression ◽  
Safety Net ◽  
Multivariate Logistic Regression Model ◽  
Cystic Lesions ◽  
Factors Affecting ◽  
Safety Net Hospital ◽  
Urban Safety ◽  
Access To Primary Care

BackgroundPancreatic cystic lesions (PCLs) are a heterogenous group of lesions with varying degrees of malignant potential. PCLs are often incidentally detected on imaging. Management for patients without an immediate indication for resection or tissue sampling entails radiographic surveillance to assess for features concerning for malignant transformation. This study aims to determine the rates of adherence to surveillance recommendations for incidental PCLs, and identify factors associated with adherence or loss of follow-up.MethodsWe conducted a single-centre retrospective study of patients at a tertiary safety net hospital with incidentally discovered asymptomatic PCLs. Follow-up was defined as having undergone repeat imaging as recommended in the radiology report. Data were analysed using logistic regression.ResultsWithin our cohort (n=172), 123 (71.5%) subjects completed follow-up imaging. Attending a gastroenterology appointment was most strongly associated with completing follow-up for PCLs and remained significant (p=0.001) in a multivariate logistic regression model. Subjects without a documented primary care provider were less likely to have follow-up (p=0.028). Larger cyst size was associated with completion of follow-up in univariate only (p=0.067).ConclusionWe found that follow-up of an incidentally discovered PCLs was completed in the majority of our subjects. Incomplete follow-up for PCLs occurred in up to one in three to four patients in our cohort. Access to primary care and utilisation of subspecialty gastroenterology care are associated with completion of follow-up for PCLs. If validated, our findings can guide potential interventions to improve follow-up rates for PCLs.

scholarly journals Patient Characteristics and Outcomes of Outpatient Parenteral Antimicrobial Therapy: A Retrospective Study

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Marie Yan ◽  
Marion Elligsen ◽  
Andrew E. Simor ◽  
Nick Daneman
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Therapy ◽  
Retrospective Chart Review ◽  
Surgical Site Infections ◽  
Patient Characteristics ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Health Care Encounters ◽  
One Year ◽  
Alternative To Hospitalization

Outpatient parenteral antimicrobial therapy (OPAT) is a safe and effective alternative to hospitalization for many patients with infectious diseases. The objective of this study was to describe the OPAT experience at a Canadian tertiary academic centre in the absence of a formal OPAT program. This was achieved through a retrospective chart review of OPAT patients discharged from Sunnybrook Health Sciences Centre within a one-year period. Between June 2012 and May 2013, 104 patients (median age 63 years) were discharged home with parenteral antimicrobials. The most commonly treated syndromes included surgical site infections (33%), osteoarticular infections (28%), and bacteremia (21%). The most frequently prescribed antimicrobials were ceftriaxone (21%) and cefazolin (20%). Only 56% of the patients received follow-up care from an infectious diseases specialist. In the 60 days following discharge, 43% of the patients returned to the emergency department, while 26% required readmission. Forty-eight percent of the return visits were due to infection relapse or treatment failure, and 23% could be attributed to OPAT-related complications. These results suggest that many OPAT patients have unplanned health care encounters because of issues related to their infection or treatment, and the creation of a formal OPAT clinic may help improve outcomes.

scholarly journals 609. Implementation and Post-implementation Analysis of a Pilot Program for Inpatient Review of Outpatient Parenteral Antimicrobial Therapy Prior to Discharge

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S365-S366
Author(s):  
Delaney Hart ◽  
Hailey McCoy ◽  
Krista Gens ◽  
Michael Wankum ◽  
Andrew Tarleton
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Therapy ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Time Frame ◽  
Blood Stream ◽  
Central Line ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Chi Squared

Abstract Background The Infectious Diseases Society of America OPAT (outpatient parenteral antimicrobial therapy) guidelines state that effective OPAT programs require a multidisciplinary team1. Currently within the health system, there is no formal OPAT program in place, and OPAT prescribing is not limited to any specialty. This project aimed to pilot a pharmacist-driven program across five hospitals. Methods Adult patients with OPAT ordered between February 1 and May 1, 2020 were included. Patients were excluded if the OPAT was prescribed by infectious diseases (ID) providers or if patients were on OPAT prior to hospital admission. An alert was generated in the electronic health record (EHR) when an order for an intravenous catheter was placed for patients with concomitant antimicrobials. Follow up was performed and documented via a progress note in the EHR as appropriate. Data was collected via retrospective chart review and statistical analysis was performed using Chi-squared test with Yates’ correction. Results 101 pre- and 7 patients post-implementation were included in this study. There were a total of 51 patients pre-implementation that received inappropriate OPAT care per the IDSA OPAT guidelines, and post-implementation 2 patients (50.5% vs 28.6%, p=0.47). The secondary outcomes of 30-day readmission rates were 17% and 0% (p=0.52); and complications related to OPAT (e.g. central-line associated blood stream infections) were 12% and 0% (p=0.73), respectively. 2 midline catheters were recommended by the OPAT team, and a cost savings of up to $6,796 was calculated. Conclusion This pilot showed a trend towards decreased inappropriate OPAT prescribing and cost avoidance of an ID pharmacist-driven review of OPAT prior to patient hospital discharge. Limitations to this pilot included being underpowered due to the limited time-frame of the post-implementation period, and an inability for follow up with patients discharged utilizing an alternative home infusion service. Disclosures All Authors: No reported disclosures

scholarly journals Current Status of Outpatient Parenteral Antimicrobial Therapy (OPAT) At a University-Affiliated Acute-Care Hospital in The Republic of Korea

2021 ◽  
Author(s):  
Eunjeong Heo ◽  
Yoonhee Choi ◽  
Hyung-sook Kim ◽  
Hyung Wook Namgung ◽  
Eunsook Lee ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Tertiary Care ◽  
Management Program ◽  
Republic Of Korea ◽  
Current Status ◽  
Care Hospital ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
The Republic ◽  
Tract Infections

Abstract Objectives The aim of this study was to describe current status of outpatient parenteral antimicrobial therapy (OPAT) at a tertiary care hospital in the Republic of Korea. Methods This retrospective study was conducted on outpatients and referral patients who had a prescription of parenteral antibiotics from July to December 2019. We reviewed the prescribed antimicrobials, the indication of antimicrobial therapy, where patients administered antimicrobial injection and management of pre- and post- prescriptions. Results Of the 577 episodes included in this study, 399 (69.2%) were delivered by referral model, 178 (30.8%) by outpatient model. About 70% of OPATs were prescribed in the pulmonology, infectious diseases, orthopedics, gastroenterology, and hematology departments. Five antibiotics (ertapenem (26.0%), ceftriaxone (12.8%), kanamycin (11.8%), amikacin (10.1%), and cefazolin (8.5%)) accounted for 69.2% of the total OPATs. Urinary tract infections (27.3%), respiratory infections (20.8%), and intra-abdominal infections (15.9%) are the most frequent indications of OPAT. After prescription, there were 295 (73.9%) follow-up visits in referral model and 150 (84.3%) in outpatient model (p<0.05). Laboratory tests necessary for monitoring were totally performed in 274 (47.5%). Conclusions We found that significant number of OPAT was prescribed, follow-up visits were not performed in about a quarter of episodes, and laboratory monitoring was not fully conducted in more than half of the cases. Therefore, it is necessary to establish an appropriate management program for OPAT. Considering limited resources and the distribution of OPAT prescriptions, it may be effective to select frequently used antibiotics or frequently prescribed departments and start the program for them.

scholarly journals 604. Factors Associated with Adverse Drug Reactions Leading to Discontinuation of Vancomycin in Outpatient Parenteral Antimicrobial Therapy

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S364-S364
Author(s):  
Josh McDonald ◽  
Russell J Benefield ◽  
Laura Certain
Keyword(s):  
Adverse Drug Reactions ◽  
Antimicrobial Therapy ◽  
Plasma Concentrations ◽  
The United States ◽  
High Rate ◽  
Unplanned Readmission ◽  
Drug Reactions ◽  
Research Support ◽  
Outpatient Parenteral Antimicrobial Therapy

Abstract Background Over 250,000 patients receive outpatient parenteral antimicrobial therapy (OPAT) in the United States each year. Vancomycin is commonly used in OPAT but has a high rate of discontinuations due to adverse drug reactions (ADRs). Being able to predict the occurrence of these ADRs and assess their impact could improve the overall quality of OPAT services when utilizing vancomycin. Methods This was a retrospective chart review of all adult University of Utah Health (UUH) patients who received vancomycin OPAT and had planned follow-up with UUH infectious disease (ID) providers between October 25, 2018 and July 31, 2019. Patients were excluded if they were less than 18 years of age, pregnant, did not have planned follow up with UUH ID physicians, or were on any form of renal replacement therapy. The primary outcome assessed was discontinuation of vancomycin due to ADR, as documented by the ID provider. Type of ADR leading to discontinuation and 30-day unplanned readmission were also assessed. Results One hundred fifty-eight patients met inclusion criteria (n=158). The mean age of patients was 55 years with a median Charlson comorbidity score of 3. Most patients utilized a non-UUH infusion service (116, 73% vs 42, 27%) and utilized vancomycin as their sole antibiotic (83, 53%). The majority of patients were being treated for orthopedic infections (78, 49%). Twenty-eight patients discontinued vancomycin OPAT due to an ADR (18%). The most common ADR leading to discontinuation was acute kidney injury (10, 36%). Variables associated with ADRs leading to discontinuation included utilization of UUH home infusion services (54% vs 21%, P &lt; 0.001) and initial vancomycin plasma concentrations obtained less than 7 days after discharge (92% vs 71%, P &lt; 0.001). The overall 30 day readmission rate was 10% and the rate among patients who experienced an ADR leading to discontinuation was higher than those who did not (25% vs 8%, P &lt; 0.001). Conclusion The overall rate of discontinuation of vancomycin OPAT due to ADR in the UUH population is similar to what has been described in previous literature. The higher rate of unplanned readmission in the population of patients who experienced ADRs warrants further study. The results of this study will be utilized for future quality improvement interventions at our institution. Disclosures Russell J. Benefield, PharmD, Merck and Co (Grant/Research Support)Paratek Pharmaceuticals (Grant/Research Support)Rempex Pharmaceuticals (Grant/Research Support)

scholarly journals 608. Impact of Implementing Pharmacist Review and Monitoring of Outpatient Parenteral Antimicrobial Therapy

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S365-S365
Author(s):  
Emily R Kirkpatrick ◽  
Elizabeth O Hand ◽  
Darrel W Hughes ◽  
Jasmin K Badwal ◽  
Kristi A Traugott
Keyword(s):  
Infectious Disease ◽  
Antimicrobial Therapy ◽  
Intervention Group ◽  
Care Program ◽  
Standard Of Care ◽  
Transitions Of Care ◽  
Control Group ◽  
Laboratory Monitoring ◽  
Outpatient Parenteral Antimicrobial Therapy

Abstract Background Given current efforts to increase the safety of outpatient parenteral antimicrobial therapy (OPAT) programs nationwide, this project sought to determine whether pharmacist managed OPAT review and monitoring improves adherence to standard of care laboratory monitoring recommendations. Methods A single-center, retrospective review of patients &gt; 18 years of age who received OPAT from University Health System was conducted. Patients who received OPAT between October 2018 and December 2018 served as the historical control group. After a pharmacist transitions of care program was implemented, patients who received OPAT between October 2019 and December 2019 were included in the intervention group. Patients were excluded if they received less than 7 days of OPAT, completed therapy prior to discharge, or died while inpatient. The primary endpoint was adherence to laboratory monitoring recommendations &gt; 75% of the duration of planned OPAT. Only patients followed by the OPAT clinic were included in this analysis. Recommendations provided in the 2018 Infectious Diseases Society of America OPAT guidelines were used to define appropriate lab monitoring. Secondary endpoints included 30-day readmissions. Results A total of 409 patients were included in this study: 198 patients in the pre-implementation group and 211 patients in the post-implementation group. In patients with OPAT clinic follow-up, the post-implementation group was significantly more likely to receive monitoring adherent to standard of care laboratory monitoring recommendations &gt; 75% of the duration of planned OPAT: 42/161 (26.1%) vs. 98/176 (55.7%), OR 3.6 (95% CI 2.2-5.6, p = 0.0001). There was no difference in 30-day readmission rates between groups in the overall population. Patients in the post-implementation group with OPAT clinic follow up had lower 30-day infectious disease-attributed readmissions: 18/161 (11.2%) vs. 14/176 (8.0%), p = 0.31. Conclusion Implementation of a transitions of care pharmacist significantly improved adherence to laboratory monitoring recommendations for patients receiving OPAT and numerically reduced 30-day infectious disease-attributed readmissions. Disclosures All Authors: No reported disclosures

scholarly journals Outpatient Subcutaneous Antimicrobial Therapy (OSCAT) as a Measure to Improve the Quality and Efficiency of Healthcare Delivery for Patients With Serious Bacterial Infections

2020 ◽  
Vol 7 ◽  
Author(s):  
Tristan Ferry ◽  
Thomas P. Lodise ◽  
Jason C. Gallagher ◽  
Emmanuel Forestier ◽  
Sylvain Goutelle ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Bacterial Infections ◽  
Healthcare Delivery ◽  
Standard Of Care ◽  
Healthcare Services ◽  
Outpatient Setting ◽  
Tolerability Profile ◽  
Local Tolerability ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
At Home

Since the 1970s, outpatient parenteral antimicrobial therapy (OPAT) has been a viable option for patients who require intravenous antibiotics when hospitalization is not warranted. While the benefits of OPAT as a measure to improve the efficiency of healthcare delivery (i.e., reduced hospital days) and patient satisfaction are well-documented, OPAT is associated with a number of challenges, including line complications and reliance on daily healthcare interactions in some cases at home or in a clinic. To minimize the continued need for intensive healthcare services in the outpatient setting, there is trend toward patients self-administering antibiotics at home without the presence of healthcare workers, after adequate training. In most cases, patients administer the antibiotics through an established intravenous catheter. While this OPAT practice is becoming more accepted as a standard of care, the potential for line complications still exists. Outpatient subcutaneous antimicrobial therapy (OSCAT) has become an increasingly accepted alternative route of administration of antibiotics to IV by French infectious diseases physicians and geriatricians; however, currently, no antibiotics are approved to be administered subcutaneously. Antibiotics with longer half-lives that are completely absorbed and have a favorable local tolerability profile are ideal candidates for OSCAT and have the potential to maximize the quality and efficiency of parenteral antibiotic delivery in the outpatient setting. The increasing development of wearable, on-body subcutaneous delivery systems make OSCAT even more viable as they increase patient independence while avoiding line complications and potentially removing the need for direct healthcare professional observation.

Risk factors for amendment in type, duration and setting of prescribed outpatient parenteral antimicrobial therapy (OPAT) for adult patients with cellulitis: a retrospective cohort study and CART analysis

2017 ◽  
Vol 94 (1107) ◽  
pp. 25-31 ◽  
Author(s):  
Michael Quirke ◽  
Emma May Curran ◽  
Patrick O’Kelly ◽  
Ruth Moran ◽  
Eimear Daly ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cohort Study ◽  
Antimicrobial Therapy ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Adult Patients ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Cart Analysis ◽  
Cart Algorithm

Purpose of the studyTo measure the percentage rate and risk factors for amendment in the type, duration and setting of outpatient parenteral antimicrobial therapy (OPAT) for the treatment of cellulitis.Study designA retrospective cohort study of adult patients receiving OPAT for cellulitis was performed. Treatment amendment (TA) was defined as hospital admission or change in antibiotic therapy in order to achieve clinical response. Multivariable logistic regression (MVLR) and classification and regression tree (CART) analysis were performed.ResultsThere were 307 patients enrolled. TA occurred in 36 patients (11.7%). Significant risk factors for TA on MVLR were increased age, increased Numerical Pain Scale Score (NPSS) and immunocompromise. The median OPAT duration was 7 days. Increased age, heart rate and C reactive protein were associated with treatment prolongation. CART analysis selected age <64.5 years, female gender and NPSS <2.5 in the final model, generating a low-sensitivity (27.8%), high-specificity (97.1%) decision tree.ConclusionsIncreased age, NPSS and immunocompromise were associated with OPAT amendment. These identified risk factors can be used to support an evidence-based approach to patient selection for OPAT in cellulitis. The CART algorithm has good specificity but lacks sensitivity and is shown to be inferior in this study to logistic regression modelling.

scholarly journals Experience with Liposomal Amphotericin B in Outpatient Parenteral Antimicrobial Therapy (OPAT)

2021 ◽  
Author(s):  
Yvonne J. Burnett ◽  
Andrej Spec ◽  
Mohamed M. Ahmed ◽  
William G. Powderly ◽  
Yasir Hamad
Keyword(s):  
Amphotericin B ◽  
Antimicrobial Therapy ◽  
Liposomal Amphotericin ◽  
Kidney Injury ◽  
Outpatient Setting ◽  
Primary Objective ◽  
Liposomal Amphotericin B ◽  
Close Monitoring ◽  
Outpatient Parenteral Antimicrobial Therapy

Background: Outpatient parenteral antimicrobial therapy (OPAT) is a safe, effective, and convenient treatment strategy for patients receiving intravenous antimicrobials in the outpatient setting; however, data is limited describing the use and safety of liposomal amphotericin B (L-AMB). Methods: Records of patients receiving L-AMB OPAT between 1/1/2015 and 7/31/2018 were retrospectively reviewed. The primary objective was to describe the OPAT patient population discharged on L-AMB and evaluate factors associated with readmission and adverse events (AE). Analysis was performed to evaluate for predictors of worse outcomes. Results: Forty-two patients (67% male, median age 50 years) were identified, most commonly treated for histoplasmosis. The most common doses of L-AMB were 3 mg/kg (n=16, 38%) or 5 mg/kg (n=14, 33%) based on actual body weight. Twenty-six (62%) patients completed their anticipated course of L-AMB. Twenty-two (52%) patients were readmitted within 30 days of discharge, median time to readmission was 11 days (Interquartile range [IQR] 5-18). While hypokalemia and acute kidney injury (AKI) were common, occurring in 26 (62%) and 20 (48%), respectively, only 5 (12%) were readmitted to the hospital due L-AMB-associated AE. Ninety percent of patients achieved at least partial renal recovery within 30 days after L-AMB discontinuation. Factors significantly associated with AKI include higher L-AMB dose, lower serum potassium levels after therapy initiation, and receipt of potassium supplementation at discharge. Conclusion: L-AMB is associated with significant AEs; however, these results suggest treatment is feasible in the outpatient setting with close monitoring, as the majority of AEs were managed effectively as an outpatient without long-term sequelae.

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