PWUD discharged to skilled nursing facilities often do not complete OPAT
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Many people who use drugs who are sent to skilled nursing facilities for outpatient parenteral antibiotic therapy do not complete treatment, according to findings from a single-center study published in Open Forum Infectious Diseases.
“This study was prompted by our institution's interest in providing patient-centered care for a majority uninsured population,” Bilal Ashraf, MD, resident in the department of internal medicine and pediatrics at UT Southwestern Medical Center, told Healio.
“Second, our standard of care in requiring people who use drugs to complete their extended course of antibiotics — via outpatient antimicrobial therapy, or OPAT — in a skilled nursing facility (SNF) is expensive, so we felt it was crucial to see if this expensive intervention was truly effective.”
Ashraf and colleagues explained that uninsured people who use drugs (PWUD) who develop infections such as osteomyelitis are ineligible to enroll in the hospital’s self-administered OPAT program and are instead sent to a SNF.
For the study, they used hospital electronic medical records to identify PWUD who were discharged to a SNF for OPAT from Jan. 17, 2017, to April 30, 2018. They collected data on demographics, drug use, discharge diagnosis, antibiotic therapy, whether patients were discharged against medical advice (AMA), and their 30-day ED use and 30-day readmission rates.
Out of 129 patients, most completed treatment (n = 83), although a sizeable number left AMA (n = 26) or were discharged early not AMA (n = 20). These patients who left early had higher rates of 30-day readmission or ED use (P = .01), higher rates of 30-day readmission alone (P = .01) but not ED use alone (P = .43) compared with patients who completed treatment, the researchers reported.
“I believe the major takeaway here is that people who use drugs are a very broad and diverse group of people. Just like other people, they have a variety of factors in their life that demand their attention, such as work and child care,” Ashraf said. “We should treat them as individuals, and it would be imperative to seek other options for people who have lower risk addictions, such as a clinic or self-administration-based OPAT model.”
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