Perspectives of United States-based Infectious Diseases Physicians on Outpatient Parenteral Antimicrobial Therapy Practice

Abstract

Background: While outpatient parenteral antimicrobial therapy (OPAT) is generally considered safe, patients are at risk for complications and thus require close monitoring. The purpose of this study is to determine how OPAT programs are structured and how United States-based infectious diseases (ID) physicians perceive barriers to safe OPAT care.

Methods: We queried members of the Emerging Infections Network (EIN) between November and December 2018 about practice patterns and barriers to providing OPAT.

Results: 672 members of the EIN (50%) responded to the survey. Seventy-five percent of respondents were actively involved in OPAT, although only 37% of respondents reported ID consultation was mandatory for OPAT. The most common location for OPAT care was at home with home-health support, followed by post-acute-care facilities. Outpatient and inpatient ID physicians were identified as being responsible for monitoring laboratory results (73% and 54% of respondents, respectively), but only 36% had a formal OPAT program. The majority of respondents reported a lack of support in data analysis (80%), information technology (66%), financial assistance (65%), and administrative assistance (60%). Perceived amount of support did not differ significantly across employment models. Inability to access laboratory results in a timely manner, lack of leadership awareness of OPAT value, and failure to communicate with other providers administering OPAT were reported as the most challenging aspects of OPAT care.

Conclusion: ID providers are highly involved in OPAT, but only a third of respondents have a dedicated OPAT program. Lack of financial and institutional support are perceived as significant barriers to providing safe OPAT care.

Keywords: Antimicrobial Use; Care Delivery; OPAT; Patient safety; Practice Management.

Figure 1.

Respondents ranked outpatient parenteral antimicrobial therapy delivery sites from the most to least common.

Figure 2.

Respondents rated the amount of time spent in a usual week managing outpatient parenteral antimicrobial therapy patients by each of the health care workers listed. The numbers are the total number of participants who responded in each category. Abbreviations: ID, infectious diseases; LPN, license practical nurse; NP, nurse practitioner; RN, registered nurse; PA, physician’s assistant.