Comparison of Outpatient Antimicrobial Therapy (OPAT) in a Physician Office Infusion Center (POIC) vs. Traditional Home Health Care (HHC)
Methods: Medical records of 3 Infectious Disease (ID) practices for pts treated with OPAT from Oct 1 to Dec 31, 2013 were reviewed. Data extracted were demographics, diagnosis, comorbidities, antimicrobial usage, length of therapy (LOT), pathogens, laboratory monitoring, follow-up visits with ID physician, and 30-day hospital admission rates. Significant differences were determined using Chi square or Fisher’s exact test (p≤0.05, significant).
Results: 172 pts in the POIC group were compared to 23 pts in the HHC group. The most frequent diagnosis in POIC was skin and soft tissue infections (SSTIs), (51%), respiratory (7%) and intra-abdominal (7%) infections; in HHC was SSTI (39%), osteomyelitis (22%) and septic arthritis (13%). Overall LOT was 24 and 26 days for the POIC and HHC group, respectively. Predominant antibiotics in POIC vs. HHC pts were vancomycin (34% vs. 26%), ceftriaxone (23% vs. 39%) and cefazolin (20% vs.17%). Polymicrobial pathogens were reported for 11/99 pts in the POIC group and 3/18 in the HHC group. Laboratory monitoring was performed as ordered for 95% of POIC pts in contrast to 67% of HHC pts (p<0.001). 96% of POIC pts complied with scheduled follow-up physician visits as opposed to 53% of HHC pts (p<0.001). Hosp admissions within 30 days of OPAT initiation were reported for 12 POIC (7%) compared to 4 pts in the HHC group (17%) (p=0.03). POIC admits included 5 worsening infections (3%), 2 catheter complications (1%), 2 drug-related adverse events (1%) and 3 conditions unrelated to infection (2%). In contrast, the HHC group had one worsening infection (4%), 2 unrelated to infection (9%) and one endocarditis pt (4%) was admitted with dehydration who eventually expired due to multi-organ system failure.
Conclusion: OPAT through POIC offers a closely supervised setting with significantly higher compliance of laboratory monitoring and follow-up physician visits accompanied by a significantly lower 30-day hospital admission rate compared to the HHC setting.
R. C. Prokesch,
R. V. Nathan, None
C. P. Schroeder, None
L. J. Van Anglen, None
K. D. Hooker, None