Follow-up Appointment Adherence of Outpatient Parenteral Antimicrobial Therapy (OPAT) Patients

Abstract

BackgroundOutpatient parenteral antibiotic therapy (OPAT) is a safe and effective care delivery system that allows patients to receive intravenous (IV) antibiotic therapy outside of the hospital. OPAT patients require frequent follow-up appointments for clinical and laboratory monitoring of common adverse outcomes of any IV antibiotic administration such as line infections, adverse drug events, and reinfection. Despite the known importance of clinical monitoring, patient factors that influence adherence to OPAT appointments are unknown. The objective of this study was to identify factors that influence adherence to OPAT appointments, in order to improve the OPAT program and make adherence easier for patients if possible.Methods80 patients undergoing OPAT between December 2014 and January 2016 were interviewed via telephone regarding the following: reasons for not showing up to appointments, when the first follow up appointment was scheduled, whether they received appointment reminders, transit time, and whether they had to make special arrangements to attend their appointments.ResultsAdherence to follow-up appointments was high (83.8%). 52.5% of initial follow-up appointments were made while patients were still in the hospital. 92% of patients received at least one reminder in the form of a letter (32%), call to cell phone (21%), call to landline (22%), email (17%), or other (1%). Participants mostly cited either transportation (23.4%) or other (30.4%), specifically not feeling well, and work as the reason for missing an appointment.ConclusionThe majority of patients attended all appointments, and of those, almost all received an appointment reminder, suggesting this is an important factor contributing to appointment adherence. These data reveal some of the barriers some patients face. Future studies can examine whether decreased appointment adherence leads to worse clinical outcomes.Figure 1Transportation and other were the most cited reasons for missing appointments.Figure 2The majority of participants received a reminder for an upcoming appointment in the form of a letter.Figure 3The majority of initial follow-up appointments were scheduled while patients were in the hospital.Disclosures G. Allison, Merck: Grant Investigator and Speaker’s Bureau, Grant recipient and Salary

Dalbavancin as Secondary Therapy for Serious Staphylococcus aureus Infections in a Vulnerable Patient Population

“…Finally, the low rate of treatment completion, high rate of loss to follow-up, and ability to track patients only in settings linked to our EHR hinder our ability to confidently assess the clinical effectiveness of dalbavancin. Unfortunately, this low rate of engagement in care and follow-up is common among PWUD [7, 16] and highlights the challenges in caring for this population. Among 101 housed and homeless PWID receiving OPAT without dalbavancin from our institution, we note a similar rate of clinical cure (49%) and a high rate of unknown outcome (47%) due to loss to follow-up [17].…”

Transition to Oral versus Continued Intravenous Antibiotics for Patients with Pyogenic Liver Abscesses: A Retrospective Analysis

“…24 Another study of 80 patients assessed OPAT appointment adherence and found that 84% of patients, who received at least one appointment reminder, came to follow-up appointments. 25 To our knowledge, no data have described adherence to self-administered IV antibiotics.…”

“…Adherence to PO antibiotics when measured using the Medication Event Monitoring System (Aprex, Union City, CA, USA) was reported to be between 18% and 57% . In comparison, adherence to antibiotics for patients receiving outpatient parenteral antibiotic therapy (OPAT) is consistently at or above 80% .…”

“…A study including 333 patient in the Veterans Administration system reported that 87% of patients who were defined as homeless successfully completed a defined course of parenteral antibiotic therapy . Another study of 80 patients assessed OPAT appointment adherence and found that 84% of patients, who received at least one appointment reminder, came to follow‐up appointments . To our knowledge, no data have described adherence to self‐administered IV antibiotics.…”

“…[21][22][23] In comparison, adherence to antibiotics for patients receiving outpatient parenteral antibiotic therapy (OPAT) is consistently at or above 80%. 24,25 A study including 333 patient in the Veterans Administration system reported that 87% of patients who were defined as homeless successfully completed a defined course of parenteral antibiotic therapy. 24 Another study of 80 patients assessed OPAT appointment adherence and found that 84% of patients, who received at least one appointment reminder, came to follow-up appointments.…”