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OPTIONS-DC: Treatment Course Outcomes Following Outpatient Parenteral Antimicrobial Therapy RN-Led Multidisciplinary
Alyse H Douglass1, Heather Mayer1, Kathleen Young1
1Division of Infectious Diseases, Oregon Health & Science University School of Medicine, Portland, Oregon, USA.
Background:
Care of people who use drugs with infections and recommendations for long-term intravenous (IV) antimicrobials can be challenging. OPTIONS-DC is a multidisciplinary care conference developed in 2018 that utilizes a standardized conference tool led by outpatient parenteral antimicrobial therapy (OPAT) registered nurses (RNs) to guide treatment and discharge planning while focusing on harm reduction, ethical principles, and patient preferences. We describe treatment outcomes associated with OPTIONS-DC over the first 4 years of implementation.
Methods:
Eligibility for OPTIONS-DC included history of substance use and recommendation for ≥10 days of IV antimicrobials. Conference data were collected prospectively; treatment course outcomes were collected retrospectively via a REDCap database.
Results:
A total of 229 conferences were conducted for 202 unique patients between February 2018 and April 2022. Median conference length was 28 (interquartile range [IQR], 23.8-33.0) minutes. Median age was 38 years, 214 (93.5%) had active substance use, and 77 (33.6%) were houseless. The median recommended antimicrobial duration was 6 (IQR, 4-6) weeks. A total of 172 (75.1%) patients completed their antimicrobial course (80 [46.5%] inpatient and 92 [53.5%] outpatient). Average out-of-hospital antimicrobial days was 28.7 (standard deviation, 19.6). On multivariate analysis, having a primary care provider at the time of conference was associated with treatment completion (odds ratio, 4.50 [95% confidence interval, 1.55-13.07]; P < .01).
Conclusions:
The OPAT RN-led OPTIONS-DC discharge planning conference is associated with high antimicrobial course completion rates, out-of-hospital completion, and out-of-hospital antimicrobial days.
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