Issue: December 2019
November 26, 2019
2 min read

More financial, institutional support needed for safe OPAT care

Issue: December 2019
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Raghavendra Tirupathi, MD, FACP
Raghavendra Tirupathi

A survey completed by 672 members of the Emerging Infections Network showed that infectious disease clinicians were “highly involved” in outpatient parenteral antimicrobial therapy, or OPAT, but that only around one-third of respondents reported access to a dedicated OPAT program.

Respondents identified lack of financial and institutional support as barriers to safe OPAT care, study authors reported.

Infectious Disease News Editorial Board Member Raghavendra Tirupathi, MD, FACP, medical director of Keystone Infectious Diseases/HIV, chair of infection prevention at Summit Health and clinical assistant professor of medicine at Penn State University School of Medicine, said OPAT presents unique challenges and benefits.

“OPAT is a convenient and cost-effective approach for delivering parenteral antibiotics outside the hospital setting as it shortens length of hospital stays and decreases health care spending. However, it is also a relatively high-risk intervention with [the] possibility of therapy-related complications and treatment failure,” he said.

Researchers sent a similar survey to Emerging Infections Network (EIN) members in 2013 and only one-quarter reported having a dedicated OPAT program, compared with one-third in 2019.

“This is important. OPAT use is increasing nationwide, and managing these patients is resource- and time-intensive, with little institutional support or support from payors,” Sara C. Keller, MD, MPH, MSHP, assistant professor of medicine in the division of infectious diseases and director of the Patient Safety and Quality Improvement Pathway and Osler Medical Training Program at the Johns Hopkins University School of Medicine, told Healio.

Keller and colleagues surveyed EIN members in November and December of last year, asking about OPAT program structure and perceived barriers to safe OPAT care. Half of EIN members completed the survey, of which 75% reported being actively involved in OPAT. ID consultation for OPAT was mandatory for only 37% of respondents.

According to Keller and colleagues, 73% of respondents reported that outpatient ID physicians were responsible for monitoring lab results, whereas 54% reported that inpatient ID physicians shouldered the responsibility. Only 36% of respondents said they had a formal OPAT program, according to the study. Respondents reported spending at least 4 hours a week on OPAT duties.

Keller underscored that respondents most noted low hospitalwide support and extra time needed for the work as barriers to the success of OPAT programs.

“To improve the safety of patients on OPAT, we need to address the barriers, including the lack of laboratory results returning in a timely fashion; struggles communicating with skilled nursing facilities, home infusion agencies, infusion centers, or others providing the antimicrobials; following up with infectious diseases; volume of test results to review; difficulties using the electronic medical record system; and perhaps most importantly, leadership not valuing OPAT,” Keller said.


The researchers also identified a lack of support in data analysis, information technology (IT), financial assistance and administrative assistance.

“I think the solution needs to come from getting more support and resources for ID physicians following OPAT patients, especially with care coordination and tracking of test results, and with improved compensation,” Keller said. “For this to happen, leadership and payors need to value OPAT.”

Tirupathi echoed this sentiment, suggesting that financial and institutional investment may be dependent on convincing the C suite of the value of a dedicated OPAT program, which is important if quality of care is to be improved.

“Administrative, data and IT support for OPAT needs to be boosted across all treatment settings,” he said. “More studies are needed to look for innovative delivery models of OPAT like self-OPAT, where family members perform most home OPAT care under the supervision of ID office. Poor Medicare and insurance coverage for OPAT and associated services also needs to be addressed.” – by Marley Ghizzone


Hamad Y, et al. Open Forum Infect Dis. 2019;doi:10.1093/ofid/ofz363.

Disclosures: The authors report no relevant financial disclosures. Tirupathi reports no relevant financial disclosures.