A national survey of infectious disease practitioners on their use of outpatient parenteral antimicrobial therapy (OPAT)

Abstract

Background: The use of outpatient parenteral antimicrobial therapy (OPAT) is standard medical practice; however, significant heterogeneity in practice exists. We hypothesized that formal OPAT programs are associated with increased physician participation in patient safety activities. Methods: United States Infectious Disease (ID) physicians were contacted and asked to participate in an electronic survey from April through June 2012. Data were analyzed using SPSS version 20. Results: In all, 3718 physicians were contacted and 316 (8.5%) responded. Respondents practice in 47 states; the majority (79%) practice adult ID, 11% pediatric ID, 10% a combination of the two. Sixty percent reported that ID consultation was not mandatory before OPAT, and 75% of these respondents thought it should be compulsory. The most common indications were osteomyelitis, prosthetic joint infections, and endocarditis, and the most common antibiotics were vancomycin, ceftriaxone, and ertapenem. Most respondents (59%) discharge patients with OPAT weekly, and have a median number of 11 OPAT patients (95% confidence interval (CI) 8.5–13.4). Half of respondents have a formal OPAT program. Fifty-two percent report no systematic method of communication between inpatient and outpatient physicians when patients are discharged with OPAT, 49% have no systematic method of lab tracking, and 34% have no method of ensuring patient adherence to clinic visits. All of these patient safety measures were more likely to be present in practice sites with formal OPAT programs (p < 0.001). Conclusions: Opportunities exist for improving OPAT monitoring and patient safety. Formal OPAT programs provide the framework for safe and effective care and are to be encouraged.

Keywords::

• OPAT
• outpatient parenteral antimicrobial therapy
• survey
• patient safety
• infectious diseases

Acknowledgments

Dr Eavan G. Muldoon is the inaugural recipient of the Francis P. Tally endowed fellowship in infectious diseases, Tufts Medical Center. Dr Geneve M. Allison was supported by the National Center for Research Resources grant no. UL1RR025752, now the National Center for Advancing Translational Sciences, National Institutes of Health grant no. UL1 TR000073, and the National Cancer Institute grant no. KM1 CA156726. The CTSI survey development project was supported by the National Center for Research Resources grant no. UL1 RR025752 and the National Center for Advancing Translational Sciences, National Institutes of Health, grant no. UL1 TR000073. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Supplementary material available online

Supplementary Figures 1–2.