OPAT programs are widely accepted models for the delivery of outpatient IV antibiotics. Baseline 30 day re-admission rates were 32% among patient discharged on IV antibiotics at our center who were followed by their treating physician. The objective of this study was to measure the impact of pharmacist-based management on 30 day re-admission rates.
Patients followed by the Infectious Diseases inpatient service were monitored by a pharmacist-based OPAT program from 12/2013 to 1/2015. Pharmacists operated under a collaborative practice agreement to monitor lab values, as outlined by IDSA guidelines, and adjust dosing regimens. Any change in drug selection or discontinuation of therapy was at the sole discretion of the monitoring ID physician.
A total of 1039 patients were followed, 439 by an ID trained pharmacist during the intervention period; 600 by a non-ID trained pharmacist. Vancomycin was the most predominant antibiotic prescribed. Indications for OPAT included endocarditis, brain abscess, empyema, line infections, bacteremia, osteomyelitis, and joint infections. During our intervention period, we were able to demonstrate a reduction in 30 day readmission rate to 18%. The 30 day readmission rate increased after our intervention period to an average of 24%; however, we were able to maintain an overall reduction in all cause readmission rates with ongoing non-ID trained pharmacist monitoring. Most patients were readmitted for reasons not related to their infection. 57 patients were admitted with ongoing infections (n=57), new infections (n=22), adverse event related to antibiotics or PICC lines (n=21), and for other reasons (n=122). Other reasons varied from MI, GI bleed, and COPD exacerbation. During our intervention period 38 of 439 (8.7%) vs 62 of 600 (10.3%) of patients were admitted with new or ongoing infection or adverse events related to their antibiotic or PICC line.
Pharmacist monitoring of patients on OPAT may be a cost-effective method to reduce readmission rates and improve outcomes.
Astellas: Investigator , Research grant
B. Falcione, Hospira: Investigator , Co-investigator for an unrelated research study for which financial support was provided to the University of Pittsburgh
T. Glowa, None
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