742. The Development, Implementation, and Feasibility of Multidisciplinary Treatment Planning Conference for Individuals with Unstable Substance Use Disorders and Active Infections Requiring Prolonged Antimicrobial Therapy: The OPTIONS-DC Model

Abstract

BackgroundOutpatient parenteral antimicrobial therapy (OPAT), widely used for serious infections, has high failure rates in people with substances use disorders (SUD)1–2. At our institution, completing therapy in the hospital was previously the best option for high-risk patients; but long hospital stays are often unacceptable to patients and costly. To improve outcomes, our Infectious Diseases division, OPAT program, and Improving Addiction Care Team (IMPACT) developed and implemented a novel multidisciplinary conference (OPTIONS-DC) for inpatients with SUD requiring prolonged antibiotics. This study describes the conference development, tool, and initial experience.MethodsFrom June 2017 to June 2018, diverse stakeholders collaboratively created and implemented a structured conference to discuss treatment options that balance medical efficacy, patient preferences, and feasibility using harm-reduction principles. After 10 months of hospital-wide implementation, we elicited provider feedback and performed a content analysis of OPTIONS-DC notes and patient records to evaluate the impact.ResultsThe goal of conference development was prioritizing patient preferences and engaging multidisciplinary input. One RN facilitates the conference using the tool (Figure 1) to elicit input from the relevant providers. The tool systematically addresses components that may predict treatment success (i.e., working phone) while emphasizing patient preference and harm reduction. The IMPACT social work PICC safety assessment informs risks for IV access. Antibiotic recommendations are not a binary of optimal/suboptimal choices for the infection but options that best fit patient context. The average conference length was 28 minutes (IQR 21). Preliminary data shows good clinical outcomes and savings to inpatient days and cost. Initial feedback suggests the model was positively experienced by medical providers (Figure 2) and supported patient preferences.ConclusionA multidisciplinary patient-centered conference that prioritizes patient preference and uses harm-reduction principles for this high-risk population is practical, effective, and positively experienced by providers. This model may serve as a roadmap for other institutions. Disclosures All authors: No reported disclosures.

Patients With Serious Injection Drug Use–Related Infections who Experience Patient-Directed Discharges on Oral Antibiotics Have High Rates of Antibiotic Adherence but Require Multidisciplinary Outpatient Support for Retention in Care

“…For patients who elect not to continue standard IV antibiotic treatment regimens, a patient-centered approach including access to alternative antibiotic options has been described with positive outcomes [ 6 , 7 ]. Both long-acting lipoglycopeptides and oral antibiotics have been proposed as options for PWID who request patient-directed discharges (PDD) before completion of IV antibiotic therapy [ 8 , 9 ].…”

Description and outcomes of patients with substance use disorder with serious bacterial infections who had a multidisciplinary care conference

“…The goal of the conference is to improve outcomes in patients with SUDs and infections requiring long-term antibiotic therapy by incorporating harm-reduction principles and considering patient preferences and priorities when determining treatment and disposition recommendations. 20,21 An OPTIONS-DC can be requested by anyone from the patient care team and on average occurs 2 weeks into the hospital stay once the patient is clinically stable and the ID team has recommended an antibiotic regimen. 22 Conference attendees include the ID consult service, and addiction medicine consult service comprised addiction medicine providers, social workers, and peers with lived experience in recovery, primary admitting team, case management, ID pharmacist, and an OPAT nurse who leads the meeting using a standardized conference tool.…”