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. 2018 Apr;146(6):782-787.
doi: 10.1017/S0950268818000456. Epub 2018 Mar 14.

Incidence and risk factors for healthcare utilisation among patients discharged on outpatient parenteral antimicrobial therapy

D M Jacobs  1 , W-Y Leung  1 , D Essi  1 , W Park  1 , A Shaver  1 , J Claus  2 , C Ruh  3 , G G Rao  4
Affiliations

Incidence and risk factors for healthcare utilisation among patients discharged on outpatient parenteral antimicrobial therapy

D M Jacobs et al. Epidemiol Infect. 2018 Apr.

Abstract

Outpatient parenteral antimicrobial therapy (OPAT) programmes facilitate hospital discharge, but patients remain at risk of complications and consequent healthcare utilisation (HCU). Here we elucidated the incidence of and risk factors associated with HCU in OPAT patients. This was a retrospective, single-centre, case-control study of adult patients discharged on OPAT. Cases (n = 63) and controls (n = 126) were patients that did or did not utilise the healthcare system within 60 days. Characteristics associated with HCU in bivariate analysis (P ≤ 0.2) were included in a multivariable logistic regression model. Variables were retained in the final model if they were independently (P < 0.05) associated with 60-day HCU. Among all study patients, the mean age was 55 ± 16, 65% were men, and wound infection (22%) and cellulitis (14%) were common diagnoses. The cumulative incidence of 60-day unplanned HCU was 27% with a disproportionately higher incidence in the first 30 days (21%). A statin at discharge (adjusted odds ratios (aOR) 0.23, 95% confidence intervals (CIs) 0.09-0.57), number of prior admissions in past 12 months (aOR 1.48, 95% CIs 1.05-2.10), and a sepsis diagnosis (aOR 4.62, 95% CIs 1.23-17.3) were independently associated with HCU. HCU was most commonly due to non-infection related complications (44%) and worsening primary infection (31%). There are multiple risk factors for HCU in OPAT patients, and formal OPAT clinics may help to risk stratify and target the highest risk groups.

Keywords: Healthcare utilisation; OPAT; hospital readmission.

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Conflict of interest statement

Authors have nothing to declare.

Figures

Fig. 1.
Fig. 1.
Flowchart of the inclusion and exclusion process. PICC, peripherally inserted central catheter; AMA, against medical advice; OPAT, outpatient parenteral antimicrobial therapy. Other includes: PICC for reasons other than antimicrobial agent (n = 15), patient located in prison (n = 14), planned readmission within 30 days (n = 8). (*41 controls did not match cases).
See this image and copyright information in PMC

References

    1. Tice AD, et al. (2004) Practice guidelines for outpatient parenteral antimicrobial therapy. IDSA guidelines. Clinical Infectious Diseases: an Official Publication of the Infectious Diseases Society of America 38(12), 1651–1672. - PubMed
    1. Williams DN, et al. (1997) Practice guidelines for community-based parenteral anti-infective therapy. ISDA practice guidelines committee. Clinical Infectious Diseases: an Official Publication of the Infectious Diseases Society of America 25(4), 787–801. - PubMed
    1. Seaton RA and Barr DA (2013) Outpatient parenteral antibiotic therapy: principles and practice. European Journal of Internal Medicine 24(7), 617–623. - PubMed
    1. Chapman AL, et al. (2009) Clinical efficacy and cost-effectiveness of outpatient parenteral antibiotic therapy (OPAT): a UK perspective. Journal of Antimicrobial Chemotherapy 64(6), 1316–1324. - PubMed
    1. Wai AO, et al. (2000) Cost analysis of an adult outpatient parenteral antibiotic therapy (OPAT) programme. A Canadian teaching hospital and ministry of health perspective. PharmacoEconomics 18(5), 451–457. - PubMed

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