High Inpatient Health Care Utilization and Charges Associated With Injection Drug Use–Related Infections: A Cohort Study, 2012–2015

Rapoport, Alison B; Fine, Danielle R.; Manne‐Goehler, Jennifer; Herzig, Shoshana J.; Rowley, Christopher F

doi:10.1093/ofid/ofab009

Cited by 7 publications

(6 citation statements)

References 7 publications

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“…In our regional health care system, PWID are not currently eligible for home OPAT, with most remaining in acute care hospitals for the duration of recommended IV antimicrobial therapy. This situation presents a significant economic strain on health care systems and a challenge for many patients [ 3 , 4 ]. For example, PWID often struggle with hospital polices regarding leaving their rooms, and many patients may leave against medical advice before recommended antimicrobial completion [ 5 ].…”

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confidence: 99%

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

Lewis

Liang

Schwarz

et al. 2022

Open Forum Infectious Diseases

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Background Persons who inject drugs (PWID) are frequently admitted for serious injection related infections (SIRI). Outcomes and adherence to oral antibiotics for PWID with patient directed discharge (PDD) remain understudied. Methods We conducted a prospective multicenter bundled quality improvement project of PWID with SIRI at 3 hospitals in Missouri. All PWID with SIRI were offered multidisciplinary care while inpatient, including the option of addiction medicine consultation and medications for opioid use disorder (MOUD). All patients were offered oral antibiotics in the event of a PDD either at discharge, or immediately after discharge through an ID telemedicine clinic. Additional support services included health coaches, therapist, case manager, free clinic follow up, and medications in an outpatient bridge program. Patient demographics, comorbidities, 90-day readmissions, and substance use disorder clinic follow up were compared between PWID with PDD on oral antibiotics and those that completed IV antibiotics, using an as treated approach. Results Of 166 PWID with SIRI, 61 completed IV antibiotics inpatient (37%) while 105 had a PDD on oral antibiotics (63%). There was no significant difference in 90-day readmission rates between groups (p=0.819). For PWID with a PDD on oral antibiotics, 7.6% had documented non-adherence to antibiotics, 67% had documented adherence and 23% were lost to follow-up. Factors protective against readmission included antibiotic and MOUD adherence, engagement with support team, and clinic follow up. Conclusions PWID with SIRI who experience a PDD should be provided with oral antibiotics. Multidisciplinary outpatient support services are needed for PWID with PDD on oral antibiotics.

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confidence: 99%

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

Lewis

Liang

Schwarz

et al. 2022

Open Forum Infectious Diseases

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“…Thirty-day readmission rates following patient-directed discharge during infection treatment are consistently elevated across studies [12,[17][18][19], indicating the potential for ineffective treatment. Our findings of high 30-day and one-year readmission rates among persons who use drugs with patient-directed discharge are consistent with existing data.…”

Section: Discussionmentioning

confidence: 99%

Patient-Directed Discharges Among Persons Who Use Drugs Hospitalized with Invasive Staphylococcus aureus Infections: Opportunities for Improvement

Appa

Adamo

et al. 2022

The American Journal of Medicine

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…[4][5][6] A recent study demonstrates that admission for infections in PWID is associated with higher average hospital costs and longer lengths of stay compared with an inpatient cohort without SUDs. 7 Moreover, patients with housing instability and SUDs have low rates of infection treatment completion compared with those with only one or neither of these risk factors. 8,9 Mortality rates are also higher in patients with unplanned or premature discharges.…”

Section: Introductionmentioning

confidence: 99%

“…[11][12][13] Infectious diseases (ID) providers note many obstacles in providing care for PWID with infections, which has led a number of institutions to establish tools to better incorporate SUD and infection treatment while optimizing safe discharges. 7,14,15 The importance of a multidisciplinary treatment approach has been recognized in a variety of complex infections. [16][17][18][19] In February 2018, our academic medical center instituted a multidisciplinary discharge planning conference, 'OPTIONS-DC'.…”

Section: Introductionmentioning

confidence: 99%

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

Conte

Schneider

Varley

et al. 2022

Therapeutic Advances in Infection

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Background: Patients with substance use disorders (SUDs) and severe bacterial infections requiring prolonged antibiotic therapy represent a significant challenge to providers due to complexity of care coordination required to ensure safe and effective treatment. Our institution developed a patient-centered multidisciplinary discharge planning conference, OPTIONS-DC, to address this challenge. Methods: We conducted a retrospective review to evaluates parameters between patients who received an OPTIONS-DC and those who did not. Results: We identified 73 patients receiving an OPTIONS-DC and 100 who did not. More patients with an OPTIONS-DC were < 40 years of age (76.7% versus 61.0%, OR = 2.3, 95% CI = 1.1–4.7, p = 0.02), had positive HCV antibody testing (58.9% versus 41.0%, OR = 2.1, 95% CI = 1.1–3.8, p = 0.02), injection drug use (93.2% versus 79.0%, OR = 3.6 95% CI = 1.3–10.1, p = 0.01), used methamphetamines (84.9% versus 72.0%, OR = 2.2, 95% CI = 1.0–4.8, p = 0.04), and started inpatient SUD treatment (80.8% versus 63%, OR = 2.5, 95% CI = 1.2–5.0, p = 0.04) compared with those without a conference. The OPTIONS-DC group was more likely to be diagnosed with bacteremia (74.0% versus 57.0%, OR = 2.1, 95% CI = 1.1–4.1, p = 0.02), endocarditis (39.7% versus21.0%, OR = 2.5, 95% CI = 1.3–4.9, p = 0.03), vertebral osteomyelitis (45.2% versus 15.0%, OR = 4.7, 95% CI = 2.3–9.6, p < 0.01), and epidural abscess (35.6% versus 10.0%, OR = 5.0, 95% CI = 2.2–11.2, p < 0.01) and require 4 weeks or more of antibiotic treatment (97.3% versus 51.1%, OR = 34.1, 95% CI = 7.9–146.7, p = 0.01). Patients with an OPTIONS-DC were also more likely to be admitted between 2019 and 2020 than between 2018 and 2019 (OR = 4.1, 95% CI = 2.1–7.9, p < 0.01). Conclusion: Patients with an OPTIONS-DC tended to have more complicated infections and longer courses of antibiotic treatment. While further research on outcomes is needed, patients receiving an OPTIONS-DC were able to successfully complete antibiotic courses across a variety of settings.

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High Inpatient Health Care Utilization and Charges Associated With Injection Drug Use–Related Infections: A Cohort Study, 2012–2015

Cited by 7 publications

References 7 publications

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

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

Patient-Directed Discharges Among Persons Who Use Drugs Hospitalized with Invasive Staphylococcus aureus Infections: Opportunities for Improvement

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

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