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 > 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 > 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 > 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 Impact of pharmacist-conducted anticoagulation patient education and telephone follow-up on transitions of care: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lamis R. Karaoui ◽  
Elsy Ramia ◽  
Hanine Mansour ◽  
Nisrine Haddad ◽  
Nibal Chamoun
Keyword(s):  
Tertiary Care ◽  
Intervention Group ◽  
Bleeding Event ◽  
Transitions Of Care ◽  
Control Group ◽  
Published Data ◽  
Post Discharge ◽  
Readmission Rates ◽  
The Impact

Abstract Background There is limited published data in Lebanon evaluating the impact of supplemental education for anticoagulants use, especially DOACs, on clinical outcomes such as bleeding. The study aims to assess the impact of pharmacist-conducted anticoagulation education and follow-up on bleeding and readmission rates. Methods This study was a randomized, non-blinded interventional study conducted between August 2017 and July 2019 in a tertiary care teaching Lebanese hospital. Participants were inpatients ≥18 years discharged on an oral anticoagulant for treatment. Block randomization was used. The control group received the standard nursing counseling while the intervention group additionally received pharmacy counseling. Phone call follow-ups were done on day 3 and 30 post-discharge. Primary outcomes included readmission rates and any bleeding event at day 3 and 30 post-discharge. Secondary outcomes included documented elements of education in the medical records and reported mortality upon day 30 post-discharge. Results Two hundred patients were recruited in the study (100 patients in each study arm) with a mean age of 73.9 years. In the pharmacist-counseled group, more patients contacted their physician within 3 days (14% versus 4%; p = 0.010), received explicit elements of education (p < 0.001) and documentation in the chart was better (p < 0.05). In the standard of care group, patients were more aware of their next physician appointment date (52% versus 31%, p < 0.001). No difference in bleeding rates at day 3 and 30 post-discharge was observed between the groups. Conclusions Although pharmacist-conducted anticoagulation education did not appear to reduce bleeding or readmission rates at day 30, pharmacist education significantly increased patient communication with their providers in the early days post-discharge. Trial registration Lebanon Clinical Trial Registry LBCTR2020033424. Retrospectively registered. Date of registration: 06/03/2020.

scholarly journals Impact of a Pharmacy-Driven Transitions of Care Medication Reconciliation Following Hospitalization

2020 ◽  
Vol 36 (2) ◽  
pp. 68-71
Author(s):  
Rebecca L. Stauffer ◽  
Abigail Yancey
Keyword(s):  
Medication Reconciliation ◽  
Intervention Group ◽  
Emergency Department Visits ◽  
Transitions Of Care ◽  
Control Group ◽  
Medication Discrepancies ◽  
Institutional Review ◽  
The Impact ◽  
Medication Changes

Background: Medication changes are common after hospitalizations, and medication reconciliations are one tool to help identify potential medication discrepancies. Objective: To determine the impact of a pharmacy-driven medication reconciliation service on number of medication discrepancies identified. Methods: This was a retrospective cohort, chart-review study conducted at an internal medicine outpatient clinic. Patients at least 18 years of age were eligible for inclusion if they presented for a hospital follow-up appointment within 14 days of discharge between September 1, 2015, and May 31, 2016, from a system hospital. The 2 cohorts were patients with a pharmacist-completed medication reconciliation note written in the electronic health record on the date of their hospital follow-up appointment and those without. The primary outcome was number of medication discrepancies identified during medication reconciliation. Secondary outcomes included types of discrepancies, 30-day hospital readmission, and 30-day emergency department visits. This study was approved by the facility institutional review board. Results: Seventy-nine patients were included, and 38 patients had a pharmacist-completed medication reconciliation (48%). A total of 64 medication discrepancies were identified in 26 patients; of these, 49 discrepancies were resolved during the appointment (77%). There was an average of 2.46 medication discrepancies (±2.34) per patient. The most common discrepancy was missing medications. Thirty-day readmission rate was 5.3% in the intervention group and 19.5% in the control group ( P = .054). Conclusions: A pharmacist-completed medication reconciliation identified many medication discrepancies that were then resolved. From this study, pharmacist-led medication reconciliations following hospital discharge appear valuable.

Effectiveness of a Student Pharmacist–Led Telephone Follow-Up Intervention to Improve Hemoglobin A1Cin Diabetic Patients

2019 ◽  
Vol 33 (6) ◽  
pp. 832-837 ◽  
Author(s):  
Samuel K. Peasah ◽  
Kathryn Granitz ◽  
Michelle Vu ◽  
Bobby Jacob
Keyword(s):  
Regression Model ◽  
Clinical Care ◽  
Intervention Group ◽  
Standard Of Care ◽  
Multiple Regression Model ◽  
Control Group ◽  
P Value ◽  
Diabetic Patients ◽  
Phone Calls

Objective:To evaluate the effectiveness of a student pharmacist–led telephone follow-up intervention to improve hemoglobin A1c(HbA1c) in diabetic patients.Methods:This was a prospective, randomized, pilot study to implement a telephone follow-up intervention for diabetic patients with HbA1c≥7%. Patients were recruited and randomized into intervention and control groups. All patients received standard of care. Patients in the intervention group additionally received weekly phone calls from a student pharmacist for 12 weeks to encourage medication adherence. HbA1cat baseline and end of study were measured and the data were analyzed using SAS version 9.4. Analysis included descriptive statistics and a multiple regression model to assess the association between the end of study and baseline HbA1cwhile controlling for demographics.Results:Seventy-eight patients participated and the average age was 62 (±11) years. Baseline HbA1cwas 8.2% (±1.4%) in the intervention group and 7.9% (±1.3%) in the control group. HbA1cdecreased by 0.35% in the intervention group ( P = .027) and increased by 0.338% in the control group ( P = .013). The end of study HbA1cwere higher in the control group even after controlling for baseline HbA1cs (0.5547, P value .002) in the regression model.Conclusion:Incorporating student pharmacists in physician offices to provide clinical care services could lead to improved patient outcomes and students’ clinical and research skills.

Abstract 141: Depression and Cardiovascular Disease: Improving Patient Care

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Linda Gordon ◽  
Nicole Ansani-Jankowski
Keyword(s):  
Goal Attainment ◽  
Current Practice ◽  
Intervention Group ◽  
Standard Of Care ◽  
Depression Screening ◽  
Control Group ◽  
Care Plans ◽  
Depression Education ◽  
The Impact

Background: Depression affects up to 20% of patients with coronary artery disease (CAD), diabetes mellitus (DM), and congestive heart failure (CHF); and is associated with poorer health outcomes. HEDIS Depression Care Measure Set includes the utilization of PHQ-9 survey to monitor depression and appropriate treatment and follow-up. The goal of this program is to design, implement, and measure the success of a quality improvement (QI) initiative addressing HEDIS depression measures in the cardiovascular (CV) population. Methods: First an analysis of current practice and HEDIS compliance was conducted; 2. A plan was developed to address gaps in care; 3. A QI program was executed in the cardiac catheter lab; and 4. Outcome measures and methods to determine program success were designed. Results: Current practice analysis of the catheter lab revealed that depression screening, monitoring, and follow-up were not routinely conducted. Further, it was identified that the PHQ-9 screener was available in the EMR system but not being utilized. Therefore, a QI program was designed with the following components: 1. Patients > 18 years old receive the PHQ-9 upon discharge from the catheter lab; 2. If a patient scores > 10 on the PHQ-9 they receive education and are scheduled for follow-up; 3. A clinical database collects information on Framingham risk scores, CV risks, PHQ-9 scores, medical history, and biometric data. These data are then used to provide customized CV care plans including depression education; 4. A shared medical appointment (SMA) format provides additional depression education and follow-up. This program was executed in January 2014. The outcomes plan evaluates the impact of this QI program on HEDIS goal attainment and CV care. A control group receives screening, initial education, and standard of care. The intervention group receives screening, initial education, entry into the disease management database, customized education, therapeutic lifestyle counselling, and participation in the SMA focusing on depression. Currently 39 patients are enrolled in each arm. Interim analysis reveals 100% depression screening in both groups and high rates of follow-up in the intervention group (2 initial components of the HEDIS goals). Conclusions: Implementing a multi-faceted depression screening and follow-up QI program addresses HEDIS goals and has shown initial success in closing identified gaps in care. Future implications include a comparative analysis of the QI program to standard of care on composite HEDIS depression measures and CV goal attainment.

scholarly journals An Adherence-Enhancing Program Increases Retention in Care in the Swiss HIV Cohort

2020 ◽  
Vol 7 (9) ◽  
Author(s):  
Susan Kamal ◽  
Tracy R Glass ◽  
Thanh Doco-Lecompte ◽  
Sophie Locher ◽  
Olivier Bugnon ◽  
...  
Keyword(s):  
Care Center ◽  
Intervention Group ◽  
Standard Of Care ◽  
Retention In Care ◽  
Control Group ◽  
Blood Draw ◽  
Inverse Probability ◽  
Real World Setting ◽  
Immunodeficiency Virus

Abstract Background This study tested a theory-based adherence-enhancing intervention: the “Interprofessional Medication Adherence Program” (IMAP) to increase human immunodeficiency virus (HIV) retention in care. Methods We retrospectively compared our intervention center (intervention group [IG]) with a standard of care center (control group [CG]) both participating in the Swiss HIV Cohort Study between 2004 and 2012. Endpoints were defined as &gt;6-month and &gt;12-month gaps in care for intervals of care longer than 6 and 12 months without any blood draw. Inverse probability of treatment weights was used to adjust for differences between patients at the 2 centers. Viral failure was defined as ribonucleic acid ≥50 copies/mL after 24+ weeks on antiretrovirals. Results The IG included 451 patients, CG 311. In the IG, 179 (40%) patients took part in the IMAP for a median of 27 months (interquartile range, 12–45). Gaps in care of ≥6 months were significantly more likely to happen in the CG versus IG (74.6% vs 57%, P &lt; .001). The median time until the first treatment gap was longer in the IG vs CG (120 vs 84 weeks, P &lt; .001). Gaps in care of ≥12 months evaluated in 709 (93%) patients were significantly more likely to occur in the CG compared with the IG (22.6% vs 12.5%, P &lt; .001). The rate of viral failure was significantly lower in the IG (8.3% vs 15.1%, P = .003). Conclusions This study, in a real-world setting, shows the effectiveness of the IMAP to reduce 6- and 12-month gaps in follow up among people with HIV. These results should be confirmed by studies in other settings.

scholarly journals Outpatient Parenteral Antimicrobial Therapy for Surgery Patients: A Comparison with Previous Standard of Care

2013 ◽  
Vol 24 (2) ◽  
pp. 74-78 ◽  
Author(s):  
Anjie Yang ◽  
Ron Fung ◽  
James Brunton ◽  
Linda Dresser
Keyword(s):  
Length Of Stay ◽  
Antimicrobial Therapy ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Care Facility ◽  
Standard Of Care ◽  
Surgical Patients ◽  
Control Group ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Cure Rates

BACKGROUND: Current literature reports that outpatient parenteral antimicrobial therapy (OPAT) programs improve cure rates, and reduce length of hospitalization and costs. OPAT programs are still relatively new in Canada.OBJECTIVE: To evaluate the benefits of an OPAT program initiated at a multispecialty tertiary care facility in Toronto, Ontario, compared with the previous standard of care.METHODS: The present retrospective observational study was conducted using data from a group of surgical patients who were treated for active infections. Between February 1, 2010 and November 30, 2010, a total of 108 surgical patients were enrolled in the OPAT program. Patients were matched 1:1 with historical controls discharged between January 1, 2001 and January 1, 2010 according to age, sex, type of surgery, infection and comorbidities (Charlson Comorbidity Index). Cure rate, 30-day rehospitalization and length of stay were evaluated as primary end points.RESULTS: Of 108 eligible OPAT patients, 21 were matched to the control group using the prespecified criteria. For this cohort, the OPAT program was associated with improved cure rates (OPAT 61.7% versus control 57.1%; P>0.10), reduction in rehospitalization rate (14.3% versus 28.6%; P>0.10) and reduced length of stay (10.7 versus 13.9 days, P>0.10) compared with the control group.CONCLUSIONS: For this cohort of surgery patients, the OPAT program demonstrated a trend toward improved outcomes but did not achieve statistical significance. Due to the lack of statistical power, further evaluation is required to determine the full benefit of OPAT to patients and the health care system.

scholarly journals 126. evaluation of Addition of Outpatient Parenteral Antimicrobial Therapy and Orthopedic ID Resources to Transitions-of-care Outcomes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S192-S193
Author(s):  
Brett Young ◽  
Scott Bergman ◽  
Trevor C Van Schooneveld ◽  
Nicolas W Cortes-Penfield ◽  
Bryan Alexander
Keyword(s):  
Infectious Disease ◽  
Clinical Outcomes ◽  
Antimicrobial Therapy ◽  
Hospital Readmission ◽  
Academic Medical Center ◽  
Transitions Of Care ◽  
Day Hospital ◽  
Consult Service ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
The Impact

Abstract Background Our large academic medical center initiated both an Outpatient Parenteral Antimicrobial Therapy (OPAT) program supported by an infectious disease trained pharmacist, along with an Orthopedic Infectious Disease (OID) consult service to assist in caring for these specialized populations. We measured the impact of these services. Methods Patients discharged on parenteral antimicrobial therapy were divided into two groups. The pre-OPAT cohort included all patient receiving OPAT from 4/1/18 - 10/31/18; the post-OPAT cohort included all patients who received OPAT from 4/1/19 - 10/31/19 with OPAT consult (Fig 1). The OID consult service began in September 2018 prior to initiation of the OPAT program. The primary outcome was 30-day hospital readmission. Secondary outcomes included: length of stay (LOS), 90-day readmission, clinical outcomes, and identification of predictors of hospital readmission. Clinical outcomes included: time from final OR visit to discharge for OID patients and optimal treatment (cefazolin, oxacillin, or nafcillin) for MSSA. Results Introduction of these programs was associated with a reduction in all-cause 30-day readmission from 39.3% to 22.9%, and a reduction in 30-day readmission for patients on-treatment from 24.6% to 15.6% (p&lt; 0.01 for both). No difference was seen in hospital LOS (8 days in each cohort). In a subgroup analysis (Fig 2), OID patients in the post-OPAT cohort saw a median reduction of 2 days (7 days to 5 days, p=0.002) in time from final OR visit to discharge. Use of optimal treatments for MSSA increased in the post-OPAT cohort compared to pre-OPAT (65.2% to 80.9%; p=0.06). The 90-day hospital readmission rate were higher in the post-OPAT cohort among patients who lived in metro-area zip codes (p=0.03). Having an established primary care physician was associated with lower 90-day hospital readmission in both the pre-and post-OPAT cohorts (p=0.05 and 0.01, respectively). Conclusion Thirty-day readmission rates among patients discharged on OPAT significantly lowered following initiation of a combination of both a pharmacist-led OPAT program and OID consult service. OPAT and OID programs accrue additional efficiencies and clinical benefits to both patients and hospitals, which can be further evaluated and used to justify such service additions. Disclosures All Authors: No reported disclosures

scholarly journals Outpatient Parenteral Antimicrobial Therapy Practices among Adult Infectious Disease Physicians

2014 ◽  
Vol 35 (7) ◽  
pp. 839-844 ◽  
Author(s):  
Michael A. Lane ◽  
Jonas Marschall ◽  
Susan E. Beekmann ◽  
Philip M. Polgreen ◽  
Ritu Banerjee ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Infectious Diseases ◽  
Antimicrobial Therapy ◽  
Practice Patterns ◽  
Laboratory Monitoring ◽  
Emerging Infections ◽  
Surveillance Network ◽  
Near Misses ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Infectious Diseases Consultation

ObjectiveTo identify current outpatient parenteral antibiotic therapy practice patterns and complications.MethodsWe administered an 11-question survey to adult infectious disease physicians participating in the Emerging Infections Network (EIN), a Centers for Disease Control and Prevention–sponsored sentinel event surveillance network in North America. The survey was distributed electronically or via facsimile in November and December 2012. Respondent demographic characteristics were obtained from EIN enrollment data.ResultsOverall, 555 (44.6%) of EIN members responded to the survey, with 450 (81%) indicating that they treated 1 or more patients with outpatient parenteral antimicrobial therapy (OPAT) during an average month. Infectious diseases consultation was reported to be required for a patient to be discharged with OPAT by 99 respondents (22%). Inpatient (282 [63%] of 449) and outpatient (232 [52%] of 449) infectious diseases physicians were frequently identified as being responsible for monitoring laboratory results. Only 26% (118 of 448) had dedicated OPAT teams at their clinical site. Few infectious diseases physicians have systems to track errors, adverse events, or “near misses” associated with OPAT (97 [22%] of 449). OPAT-associated complications were perceived to be rare. Among respondents, 80% reported line occlusion or clotting as the most common complication (occurring in 6% of patients or more), followed by nephrotoxicity and rash (each reported by 61%). Weekly laboratory monitoring of patients who received vancomycin was reported by 77% of respondents (343 of 445), whereas 19% of respondents (84 of 445) reported twice weekly laboratory monitoring for these patients.ConclusionsAlthough use of OPAT is common, there is significant variation in practice patterns. More uniform OPAT practices may enhance patient safety.

scholarly journals Early Infectious Disease Outpatient Follow-up of Outpatient Parenteral Antimicrobial Therapy Patients Reduces 30-Day Readmission

2019 ◽  
Vol 69 (5) ◽  
pp. 865-868 ◽  
Author(s):  
Ena Saini ◽  
Mohammad Ali ◽  
Ping Du ◽  
Tonya Crook ◽  
John Zurlo
Keyword(s):  
Infectious Disease ◽  
Antimicrobial Therapy ◽  
Odds Ratio ◽  
Lower Risk ◽  
Adjusted Odds Ratio ◽  
Case Control Study ◽  
Case Control ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Control Study

Abstract We conducted a case-control study to examine the association between outpatient infectious disease (ID) follow-up and risk of 30-day readmission in 384 patients receiving outpatient parenteral antimicrobial therapy. ID outpatient follow-up within 2 weeks was associated with lower risk of all-cause 30-day readmission (adjusted odds ratio, 0.33; P = .0001).

scholarly journals 113. Improving Transitions-of-Care for Patients Discharged on High-Risk Antimicrobial Therapy

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S171-S171
Author(s):  
Ryan Zabrosky ◽  
Ellen C Rubin ◽  
Erica Liu ◽  
Karrine Brade ◽  
Hope Serafin ◽  
...  
Keyword(s):  
Infectious Disease ◽  
High Risk ◽  
Antimicrobial Therapy ◽  
Hospital Readmissions ◽  
Transitions Of Care ◽  
Post Discharge ◽  
Healthcare Improvement ◽  
Medication Counseling ◽  
Risk Patients

Abstract Background Providing effective transitions-of-care (TOC) services improves outcomes for patients discharged on high-risk medications. Literature has shown that successful TOC for certain antimicrobials reduces hospital readmissions, medication errors, and improves post-discharge follow-up and laboratory monitoring. Prior to this quality improvement (QI) initiative, there was no formal TOC process for patients discharged on high-risk antimicrobial therapy (HAT) at our institution. Without standardization, only 55.1% of patients discharged on HAT had successful TOC. The aim of this initiative was to develop and implement a TOC protocol in at least 90% of patients discharged on HAT. Methods This QI initiative utilized the Institute of Healthcare Improvement model for improvement. A workgroup of key stakeholders developed a protocol to identify and standardize TOC services provided to patients discharged on HAT. Successful protocol completion was achieved if the following process metrics were evaluated, obtained, and documented prior to discharge: baseline laboratory values, pharmacokinetic monitoring, appropriate intravenous access, drug-drug interactions, medication availability, discharge medication counseling, and formal pharmacist documentation in a discharge note. Outcome metrics included referral to outpatient infectious disease (ID) follow-up, 90-day readmissions, and successful TOC. Balancing metrics included pharmacist time and protocol initiation for patients not discharged on HAT. Results Between October 2020 and May 2021, 218 patients met protocol inclusion criteria. Of these, 203/218 (93.1%) were appropriately identified with the new TOC process. The protocol was successfully followed in 78.9% of patients identified. Readmission rates were 42.8%, which was unchanged from baseline. Inpatient ID involvement increased from 80.9% to 95.7% and referral to outpatient ID follow-up from 59% to 94.8%. Conclusion This newly developed TOC protocol successfully identifies patients discharged on HAT, improves provision of TOC services to these high-risk patients, and significantly improves the rate of infectious disease involvement while inpatient and after discharge. Disclosures All Authors: No reported disclosures

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