A Novel Program to Provide Drug Recovery Assistance and Outpatient Parenteral Antibiotic Therapy in People Who Inject Drugs

Stephanie S Gelman; Eddie Stenehjem; Rachel A Foster; Nick Tinker; Nancy Grisel; Brandon J Webb

doi:10.1093/ofid/ofab629

A Novel Program to Provide Drug Recovery Assistance and Outpatient Parenteral Antibiotic Therapy in People Who Inject Drugs

Open Forum Infect Dis. 2021 Dec 10;9(2):ofab629. doi: 10.1093/ofid/ofab629. eCollection 2022 Feb.

Authors

Stephanie S Gelman¹, Eddie Stenehjem^{1

2}, Rachel A Foster^{1

3}, Nick Tinker^{1

3}, Nancy Grisel¹, Brandon J Webb^{1

2}

Affiliations

¹ Intermountain Healthcare, Division of Infectious Diseases and Clinical Epidemiology, Salt Lake City, Utah, USA.
² Stanford University, Division of Infectious Diseases and Geographic Medicine, Palo Alto, California, USA.
³ Intermountain Healthcare, Pharmacy Service Line, Salt Lake City, Utah, USA.

Abstract

Background: Safe hospital discharge on parenteral antibiotic therapy is challenging for people who inject drugs (PWID) admitted with serious bacterial infections (SBI). We describe a Comprehensive Care of Drug Addiction and Infection (CCDAI) program involving a partnership between Intermountain Healthcare hospitals and a detoxification facility (DF) to provide simultaneous drug recovery assistance and parenteral antibiotic therapy (DRA-OPAT).

Methods: The CCDAI program was evaluated using a pre-/poststudy design. We compared outcomes in PWID hospitalized with SBI during a 1-year postimplementation period (2018) with similar patients from a historical control period (2017), identified by propensity modeling and manual review.

Results: Eighty-seven patients were candidates for the CCDAI program in the implementation period. Thirty-five participants (40.2%) enrolled in DRA-OPAT and discharged to the DF; 16 (45.7%) completed the full outpatient parenteral antibiotic therapy (OPAT) duration. Fifty-one patients with similar characteristics were identified as a preimplementation control group. Median length of stay (LOS) was reduced from 22.9 days (interquartile interval [IQI], 9.8-42.7) to 10.6 days (IQI, 6-17.4) after program implementation (P < .0001). Total median cost decreased from $39 220.90 (IQI, $23 300.71-$82 506.66) preimplementation to $27 592.39 (IQI, $18 509.45-$48 369.11) postimplementation (P < .0001). Ninety-day readmission rates were similar (23.5% vs 24.1%; P = .8). At 1-year follow-up, all-cause mortality was 7.1% in the preimplementation group versus 1.2% postimplementation (P = .06).

Conclusions: Partnerships between hospitals and community resources hold promise for providing resource-efficient OPAT and drug recovery assistance. We observed significant reductions in LOS and cost without increases in readmission rates; 1-year mortality may have been improved. Further study is needed to optimize benefits of the program.

Keywords: OPAT; PWID; antimicrobial stewardship; substance abuse.