Ross Jennifer K, Sieling William D, Billmeyer Kaylyn N, Hirsch Elizabeth B, Evans Michael D, Kline Susan E, Galdys Alison L
M Health Fairview University of Minnesota Medical Center, Department of Pharmacy, Fairview Pharmacy Services, Minneapolis, Minnesota, USA.
University of Minnesota Medical School, Department of Medicine, Minneapolis, Minnesota, USA.
Open Forum Infect Dis. 2025 Jun 12;12(7):ofaf343. doi: 10.1093/ofid/ofaf343. eCollection 2025 Jul.
Outpatient parenteral antimicrobial therapy (OPAT) is a mechanism for delivery of antimicrobial therapy outside of inpatient care; however, risks associated with OPAT combined with transition-of-care vulnerabilities may result in unscheduled healthcare use. On 15 June 2020, our institution launched a program entailing OPAT plan review and reconciliation by infectious diseases (ID) pharmacists prior to hospital discharge. We analyzed the frequency of all-cause 90-day emergency department (ED) visits, readmissions, and mortality of patients pre- and postimplementation of OPAT plan reconciliation.
Unique, adult OPAT recipients discharged to home or a postacute care facility from an academic hospital before (1 June 2017-14 June 2020) and after (15 June 2020-30 June 2022) implementation of ID pharmacist review and reconciliation of OPAT plans were included. We performed a propensity score-weighted analysis to compare 90-day outcomes pre- and postintervention while adjusting for relevant clinical characteristics. We accounted for missing data by using multiple imputation.
A total of 2408 OPAT patients met inclusion criteria: 1650 preimplementation and 758 postimplementation. Patients in the postimplementation group had statistically fewer ED visits (pre: 22.2%; post: 17.8%; = .02) and hospital readmissions (pre: 38.9%; post: 33.4%; = .01) within 90 days after discharge from index admission when compared to the preimplementation cohort. There was no significant difference in the 90-day all-cause mortality between cohorts.
Following implementation of OPAT plan reconciliation by ID pharmacists prior to discharge from acute care, OPAT recipients were significantly less likely to experience 90-day ED visits or 90-day readmissions.
门诊胃肠外抗菌治疗（OPAT）是一种在住院治疗之外提供抗菌治疗的方式；然而，OPAT相关风险与护理过渡的脆弱性相结合可能导致非计划的医疗保健使用。2020年6月15日，我们的机构启动了一项计划，要求传染病（ID）药剂师在出院前对OPAT计划进行审查和核对。我们分析了OPAT计划核对实施前后患者90天内全因急诊就诊、再入院和死亡率的发生频率。
纳入在学术医院实施ID药剂师对OPAT计划进行审查和核对之前（2017年6月1日至2020年6月14日）和之后（2020年6月15日至2022年6月30日）出院回家或转入急性后期护理机构的成年OPAT患者。我们进行了倾向评分加权分析，以比较干预前后的90天结局，并对相关临床特征进行调整。我们使用多重填补法处理缺失数据。
共有2408例OPAT患者符合纳入标准：实施前1650例，实施后758例。与实施前队列相比，实施后组患者在首次入院出院后90天内的急诊就诊次数（实施前：22.2%；实施后：17.8%；P = 0.02）和医院再入院率（实施前：38.9%；实施后：33.4%；P = 0.01）在统计学上更少。队列之间90天全因死亡率无显著差异。
在急性护理出院前由ID药剂师实施OPAT计划核对后，OPAT接受者经历90天急诊就诊或90天再入院的可能性显著降低。
