Perspectives of United States–Based Infectious Diseases Physicians on Outpatient Parenteral Antimicrobial Therapy Practice

Hamad, Yasir; Lane, Michael A.; Beekmann, Susan E.; Polgreen, Philip M.; Keller, Sara C.

doi:10.1093/ofid/ofz363

Cited by 38 publications

(41 citation statements)

References 23 publications

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“…This strategy requires close patient follow‐up and monitoring of laboratory results to ensure safe and effective care. In addition, this approach requires a high level of coordination between hospitals, outpatient infusion facilities, and multidisciplinary coordination between clinicians, nurses, billing staff, and case management 7 . However, there are several barriers intrinsic to OPAT that compromise its safety and efficacy, thereby preventing the use of OPAT as a transition strategy.…”

Section: Barriers To Traditional Transition Strategiesmentioning

confidence: 99%

Advantages of Outpatient Treatment with Long‐Acting Lipoglycopeptides for Serious Gram‐Positive Infections: A Review

et al. 2020

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Treatment of serious gram-positive infections presents multiple challenges. Treatment often results in prolonged hospitalization for administration of intravenous antimicrobials and presents an inefficient use of hospital resources. Prolonged hospitalization is typically also unfavorable to patient preferences and potentially subjects patients to additional health care-associated complications. Current strategies of transition to outpatient settings-outpatient parenteral antimicrobial therapy and use of oral antibiotics-often do not adequately serve vulnerable populations for whom there is often no alternative to inpatient therapy. Specifically, people who use drugs, those who cannot reliably adhere to unsupervised treatment (poor mental or physical health), people with complicating life circumstances (e.g., homelessness, incarceration, rural location), and those with inadequate health insurance remain hospitalized for weeks longer than persons without such conditions. We suspected that long-acting lipoglycopeptides (laLGP), such as dalbavancin and oritavancin, may be useful in patient transitions to outpatient settings. Thus, we conducted a search of the peer-reviewed literature using the PubMed, Google Scholar, and MEDLINE databases. Based on accumulating literature, it appears that laLGPs offer a reliable alternative therapeutic strategy that addresses many of the personal and systemic barriers to the traditional transitioning approaches. Current evidence also suggests that these agents may be cost-effective from patient, payer, and hospital perspectives. Barriers to broader use of laLGPs include, among others, a relative lack of prospective data regarding efficacy in serious infections, a narrow United States Food and Drug Administration-approved indication restricted to only acute bacterial skin and skin structure infections, and lack of reimbursement infrastructure for inpatient settings.

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Section: Barriers To Traditional Transition Strategiesmentioning

confidence: 99%

Advantages of Outpatient Treatment with Long‐Acting Lipoglycopeptides for Serious Gram‐Positive Infections: A Review

et al. 2020

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“…However, the remainder estimated that in an average week, 19.2% of pharmacists dedicated no time, 26.8% dedicated minimal time (<4 hours), 21.8% dedicated moderate time (4-20 hours), and 11.7% dedicated considerable time (>20 hours) on OPAT patients. 11 These surveys have limitations, because they only survey one physician member of the OPAT team, which could bias responses to the true involvement of ID pharmacists. While relatively small, initial studies involving the inclusion of a pharmacist in the OPAT team have found an improvement in adherence to guideline-based practice (35.9% without an ID-trained pharmacist vs 100% with ID-trained pharmacist), implemented interventions for safety (implemented in 56.1% of patients) and efficacy (interventions in 28.6% of patients), decreased cost (direct cost decrease of $659/patient), and a potential decrease in 30 day readmissions (14.7% with ID-trained pharmacist vs 38.2% without ID-trained pharmacist).…”

Section: Statement Of Needmentioning

confidence: 99%

“…Almost 20% of respondents did not know the answer to this question. However, the remainder estimated that in an average week, 19.2% of pharmacists dedicated no time, 26.8% dedicated minimal time (<4 hours), 21.8% dedicated moderate time (4‐20 hours), and 11.7% dedicated considerable time (>20 hours) on OPAT patients 11 . These surveys have limitations, because they only survey one physician member of the OPAT team, which could bias responses to the true involvement of ID pharmacists.…”

Section: Statement Of Needmentioning

confidence: 99%

Role of infectious diseases pharmacists in outpatient intravenous and complex oral antimicrobial therapy: Society of Infectious Diseases Pharmacists insights

Rivera

Mehta

Ryan

et al. 2021

J Am Coll Clin Pharm

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Outpatient parenteral antimicrobial therapy (OPAT) is a well‐established mechanism to facilitate patient discharge, lower inpatient admission cost, and decrease the risk of health care–acquired infections. Although there are numerous benefits to patients and health care institutions, OPAT is complex and not without risks. Patients may be discharged on long courses of oral antimicrobials, known as complex outpatient antimicrobial therapy (COpAT), which also requires careful monitoring and oversight. This, coupled with the need for antimicrobial stewardship across the continuum of care, positions pharmacists with infectious diseases (ID) training as crucial leaders in the field of OPAT. The development, implementation, and maintenance of these services requires the careful attention of health care personnel in discharge antimicrobial selection, continuity of care at key care transitions, implementation of optimal care bundles, provision of thorough patient education throughout the OPAT process, coordination with a multidisciplinary team including home infusion and nursing, and monitoring of program metrics to determine successes and opportunities for improvement. Ongoing support for optimal delivery of patient care will be required as OPAT practice, and health care delivery at large, continues to evolve. This involves continued advocacy for collaborative practice development, optimizing payment for nondispensatory OPAT services, and integration of effective telehealth programs. This article summarizes the need for practice expansion of ID pharmacist specialists in OPAT/COpAT management across the care continuum and best practices for establishment of these services.

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“…Overall, these responses were summarized by a lack of institutional support for this modality of therapy. 13 However, research regarding the challenges related to this new modality of therapy is still minimal.…”

mentioning

confidence: 99%

Experiences in outpatient parenteral antimicrobial therapy (OPAT): Barriers and challenges from the front lines

Bailey

Pryor

et al. 2021

ASHE

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Background: Outpatient parenteral antimicrobial therapy (OPAT) is now the standard of care for managing patients who no longer need inpatient care but require prolonged intravenous antimicrobial therapy. OPAT increases patient satisfaction, reduces the lengths of hospital stay, lowers emergency department readmission rates, and decreases total healthcare spending. Objective: To investigate Virginia Commonwealth University Health System’s experience with OPAT and to highlight the obstacles patients and clinicians face when navigating and utilizing this program. Design: We conducted this descriptive study at a large, academic, tertiary-care hospital in Central Virginia. Methods: We performed manual reviews of electronic medical records of 602 patient, and we evaluated the records of those receiving OPAT between 2017 and 2020. Reviews included antimicrobial agents, diagnoses requiring OPAT, adverse effects related to antimicrobials, adverse effects related to peripherally inserted central catheters (PICC), readmission rate, discharge destination, and death. We evaluated our program with descriptive statistics. Results: Among 602 patients who received OPAT, most were diagnosed with bacteremia or musculoskeletal infections. Patients were either discharged home or to another healthcare facility, with the former comprising most of the rehospitalizations. Ertapenem and vancomycin were associated with the most adverse drug events among our cohort. Elevated transaminase levels were noted in 23% of patients. The rate of PICC-line adverse events in this study population was 0.05%. Conclusions: Our findings highlight the barriers and challenges that patients and providers face when receiving OPAT, and they can inform efforts to improve patient clinical outcomes.

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Perspectives of United States–Based Infectious Diseases Physicians on Outpatient Parenteral Antimicrobial Therapy Practice

Cited by 38 publications

References 23 publications

Advantages of Outpatient Treatment with Long‐Acting Lipoglycopeptides for Serious Gram‐Positive Infections: A Review

Advantages of Outpatient Treatment with Long‐Acting Lipoglycopeptides for Serious Gram‐Positive Infections: A Review

Role of infectious diseases pharmacists in outpatient intravenous and complex oral antimicrobial therapy: Society of Infectious Diseases Pharmacists insights

Experiences in outpatient parenteral antimicrobial therapy (OPAT): Barriers and challenges from the front lines

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