Infectious disease consultation during outpatient parenteral antimicrobial therapy, or OPAT, is associated with large and significant reductions in the rate of ED and hospital admissions in the 30 days following an index event and lower total health care spending, researchers reported in a recently published study.
According to Akshay Shah, MD, an infectious disease physician at Metro Infectious Disease Consultants in Michigan, and colleagues, ID physicians are not always consulted during the initial hospitalization or ED visit of patients who are diagnosed with an infection, nor are they always consulted during the planning or monitoring of OPAT, even though studies have consistently shown that consultation with an ID specialist after OPAT has been prescribed often leads to recommended changes in treatment.
“OPAT can be managed by specialists in infectious disease or by other physicians,” Shah and colleagues wrote. “Better management of OPAT can reduce the likelihood of readmission or ED use. The relative success of ID specialists and other physicians in managing OPAT has received little study.”
For their study, Shah and colleagues analyzed MarketScan, a national database of insurance claims, for privately insured individuals aged younger than 65 years with inpatient acute-care stays in 2013 and 2014 that were followed up by OPAT. Patients who received outpatient ID intervention were matched one-to-one with those who did not. Researchers then estimated hospital and ED admission, and total health care payments over the first 30 days following discharge. Overall, they identified 10,818 index events followed by OPAT, of which 4,317 were led by ID specialists.
Study results showed that soft tissue infection and osteomyelitis were the most common infections, each affecting more than 41% of individuals. ID-led OPAT was associated with lower 30-day odds of ED admission (OR 0.449; 95% CI, 0.311-0.645) or hospitalization (OR 0.661; 95% CI, 0.557-0.791) and reduced health care payments by $1,488.
“Additional research could improve our understanding of the contribution of ID physicians in OPAT care,” Shah and colleagues concluded. “With detailed clinical data, particularly laboratory test results, it would be possible to assess the relation of guideline-concordant OPAT to clinical and payment outcomes. It would be useful to know the relation of ID consultation to OPAT outcomes among older adults and among uninsured and disadvantaged populations.
“In the U.S. context, we must learn how ID consultation relates to OPAT outcomes within advanced payment models such as episode-based or population-based payment. One could also examine the differences in outcomes between community hospitals with and without ID specialists on staff. Finally, it would be valuable to know the impact of ID consultation on OPAT in the inpatient setting as well, both on process and on clinical outcomes.” – by Caitlyn Stulpin
Disclosures: Shah reports payments from Merck, Melinta and Theravance Biopharma. Please see the study for all other authors’ relevant financial disclosures.