Home Nurse Facilities PWUDs referred to skilled nursing facilities often do not complete the OPAT

PWUDs referred to skilled nursing facilities often do not complete the OPAT



November 16, 2021

1 min read

Disclosures: The authors do not report any relevant financial disclosures.

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According to the results of a single-center study published in Open Forum on Infectious Diseases.

Bilal Ashraf

“This study was motivated by our institution’s interest in providing patient-centered care to a predominantly uninsured population” Bilal Ashraf, MD, resident in the department of internal medicine and pediatrics at UT Southwestern Medical Center, Healio said.

Source: Adobe Stock.
People who use drugs and are referred to skilled nursing facilities for parenteral antibiotics often do not complete treatment. Credit: Adobe Stock.

“Second, our standard of care in requiring people who use medication to complete their extended antibiotic treatment – via outpatient antimicrobial therapy, or OPAT – in a skilled nursing facility (SNF) is expensive, so we thought that it was crucial to see if this an expensive intervention was really effective.

Ashraf and his colleagues explained that uninsured people who use drugs (PWUD) who develop infections such as osteomyelitis are not eligible to enroll in the hospital’s self-administered OPAT program and are instead referred to an SNF.

For the study, they used hospital electronic medical records to identify PWUDs that were referred to an SNF for OPAT from January 17, 2017 to April 30, 2018. They collected data on demographics, drug use, discharge diagnosis, antibiotic therapy, whether patients are discharged against medical advice (AMA) and their 30-day emergency department utilization and 30-day readmission rates.

Of 129 patients, most completed treatment (n = 83), although a significant number left AMA (n = 26) or left AMA prematurely (n = 20). Those patients who left prematurely had higher rates of 30-day readmission or emergency room use (P = .01), higher readmission rates at 30 days only (P = .01) but not ED used alone (P = 0.43) compared to patients who completed treatment, the researchers reported.

“I think the main takeaway here is that people who use drugs are a very large and diverse group of people. Just like other people, they have a variety of factors in their lives that demand their attention, such as work and childcare, ”Ashraf said. “We should treat them as individuals, and it would be imperative to research other options for people with low risk addictions, such as a clinic or a self-administered OPAT model.”