Outpatient parenteral antimicrobial therapy at large Veterans Administration medical center

Am J Manag Care. 2013 Sep;19(9):e317-24.

Abstract

Objectives: To evaluate our outpatient parenteral antimicrobial therapy (OPAT) program to determine its impact on infection management in a facility notable for high patient comorbidity and a large catchment area that includes most of Southern California.

Study design: Retrospective chart review.

Methods: We reviewed all episodes of patients receiving OPAT from our institution from 2006 through 2009 for patient utilization characteristics and assessment of complications.

Results: A total of 333 patients received 393 courses of OPAT for a mean of 21.1 days. Diabetes mellitus (53.5%), psychiatric disease (39%), and chronic kidney disease (31%) were common; more than half the patients lived more than 20 miles from our medical center. Osteomyelitis (39.7%) and bacteremia (19.3%) accounted for the majority of OPAT indications. Staphylococcus aureus (36.4%) was the most frequent infecting organism, and vancomycin (37.4%) was the most frequently prescribed medication. Complications including hospital readmission, adverse drug reactions, or line-related complications were noted in 96 of 393 (24.4%) episodes, but most were minor, reversible, or not directly related to the OPAT given. Serious line-related complications that required hospital readmission were noted in only 6 (1.5%) episodes. OPAT was completed as planned in 313 (79.6%) episodes; end-stage renal disease was associated with OPAT noncompletion in multivariable analysis (odds ratio = 2.20, P = .047). We estimated that OPAT saved our medical center $4 million per year.

Conclusions: Despite our patients' high level of comorbidity and our facility's large catchment area, we were able to deliver OPAT successfully and safely with significant cost savings.

MeSH terms

  • Ambulatory Care*
  • Anti-Infective Agents / administration & dosage*
  • California
  • Female
  • Hospitals, Veterans*
  • Humans
  • Infusions, Parenteral
  • Male
  • Medical Audit
  • Medication Adherence
  • Middle Aged
  • Outpatient Clinics, Hospital
  • Patient Readmission
  • Retrospective Studies

Substances

  • Anti-Infective Agents