School of Pharmacy, University of California, San Francisco, CA, USA.
Ann Pharmacother. 2011 Nov;45(11):1329-37. doi: 10.1345/aph.1Q240. Epub 2011 Oct 11.
Outpatient parenteral antimicrobial therapy (OPAT) is frequently prescribed at hospital discharge, often without infectious diseases (ID) clinician oversight. We developed a multidisciplinary team, including an ID pharmacist, to review OPAT care plans at hospital discharge to improve safety, clinical efficacy, practicality, and appropriateness of the proposed antimicrobial regimen.
To evaluate the impact of the OPAT team on regimen safety, efficacy, and complexity; calculate the economic benefits of the service by avoiding hospital discharge delay, central venous catheter placement, or need for OPAT; and evaluate the discharge environment among OPAT referrals.
In an observational design, we analyzed the impact of an OPAT team from July 2009 through June 2010 at a large academic tertiary care hospital. All patients with plans for continued parenteral therapy after discharge referred to the OPAT team were included in the analysis. Patients were excluded if OPAT was cancelled prior to processing of the referral.
During the 1-year study period, 569 of 644 consecutive referrals to the OPAT team met inclusion criteria, resulting in 494 OPAT courses. Interventions by an ID pharmacist were made for safety (56%), regimen complexity (41%), and efficacy (29%). Lack of formal ID physician consultation resulted in more interventions for safety (64% vs 48%, p < 0.001) and efficacy (36% vs 21%, p < 0.001). Discharge delays were avoided for 35 referrals, resulting in 228 hospital days avoided and approximately $366,000 in hospital bed cost savings. Use of OPAT was avoided in 75 referrals (13.2%), preventing central venous catheter placement in 48 patients (8.4%), resulting in an additional $58,080 in cost savings.
The OPAT team optimized safety, efficacy, and convenience of OPAT while providing substantial cost savings. Further studies are needed to confirm the program's cost-effectiveness.
门诊患者的肠外抗菌治疗（OPAT）经常在出院时开出处方，通常没有感染病学（ID）临床医生的监督。我们成立了一个多学科团队，包括一名 ID 药剂师，以审查出院时的 OPAT 护理计划，以提高所提议的抗菌方案的安全性、临床疗效、实用性和适当性。
评估 OPAT 团队对方案安全性、疗效和复杂性的影响；通过避免出院延迟、中心静脉导管放置或需要 OPAT 来计算该服务的经济效益；并评估 OPAT 转介患者的出院环境。
在一项观察性设计中，我们分析了 2009 年 7 月至 2010 年 6 月期间在一家大型学术三级保健医院的 OPAT 团队的影响。所有计划在出院后继续接受肠外治疗的患者都被纳入分析。如果 OPAT 在处理转介之前被取消，则将患者排除在外。
在为期 1 年的研究期间，连续转介到 OPAT 团队的 644 名患者中有 569 名符合纳入标准，共 494 名患者接受了 OPAT 治疗。ID 药剂师的干预措施是为了安全性（56%）、方案复杂性（41%）和疗效（29%）。缺乏正式的 ID 医师咨询导致更多的干预措施是为了安全性（64%比 48%，p < 0.001）和疗效（36%比 21%，p < 0.001）。避免了 35 名患者的出院延迟，从而避免了 228 个住院日和大约 366,000 美元的住院床位成本节省。75 名患者（13.2%）避免了使用 OPAT，避免了 48 名患者（8.4%）的中心静脉导管放置，从而节省了 58,080 美元的额外成本。
OPAT 团队优化了 OPAT 的安全性、疗效和便利性，同时节省了大量成本。需要进一步的研究来证实该计划的成本效益。
