Value and Clinical Impact of an Infectious Disease-Supervised Outpatient Parenteral Antibiotic Therapy Program

Abstract

Background. Outpatient parenteral antibiotic therapy (OPAT) is a safe and effective modality for treating serious infections. This study was undertaken to define the value of OPAT in a multicentered infectious disease (ID) private practice setting. Methods. Over a period of 32 months, 6120 patients were treated using 19 outpatient ID offices in 6 states. Analysis included patient demographics, indications of OPAT, diagnoses, therapeutic agent, duration of therapy, and site of therapy initiation. Outcomes were stratified by therapeutic success, clinical relapse, therapeutic complications, and hospitalizations after initiating therapy. Statistical analysis included an ordinal logistic regression analysis. Results. Forty-three percent of patients initiated therapy in an outpatient office, and 57% began therapy in a hospital. Most common diagnoses treated were bone and joint (32.2%), abscesses (18.8%), cellulitis (18.5%), and urinary tract infection (10.8%). Ninety-four percent of patients were successfully treated, and only 3% were hospitalized after beginning therapy. Most common cause of treatment failure was a relapse of primary infection (60%), progression of primary infection (21%), and therapeutic complication (19%). Conclusions. An ID-supervised OPAT program is safe, efficient, and clinically effective. By maximizing the delivery of outpatient care, OPAT provides a tangible value to hospitals, payers, and patients. This program is a distinctive competency available to ID physicians who offer this service to patients.

Dearth of infectious diseases physicians as the USA faces a global pandemic

“…In studies of patients who have been admitted to hospital, appropriate consultation with an infectious diseases specialist has resulted in shorter stays and lower antibiotic costs, 1,2 lower mortality for patients with sepsis, 3,4 and fewer complications. 5 Infectious diseases specialists are instrumental in improving transitions of care for outpatient antibiotic therapy, 6,7 and spend considerable time leading infection prevention and antimicrobial stewardship programmes that prevent the spread of hospitalacquired infections and reduce hospital costs. 8,9 Often overlooked, infectious diseases specialists also comprise pivotal teaching faculty at academic hospitals, honing the skills of the next generation of young physicians.…”

Infectious Diseases/Human Immunodeficiency Virus Physician Ambassadors: Advancing Policy to Improve Health

“…4. ID efforts often result in cost savings to hospital systems by optimizing antibiotic use and reducing the length of stay with the use of outpatient intravenous antibiotics [34].…”

The Value That Infectious Diseases Physicians Bring to the Healthcare System

“…For patients requiring OPAT, effective care transition from the inpatient to the outpatient settings was ensured at least 86% of the time. A recent study of the value of OPAT in a multicenter ID private practice setting analyzed 6120 patients treated over 32 months in 19 outpatient ID offices in 6 states [14]. Forty-three percent of patients initiated therapy in an outpatient office, and 57% began therapy in a hospital.…”