OPTIONS-DC: Treatment Course Outcomes Following Outpatient Parenteral Antimicrobial Therapy RN–Led Multidisciplinary Care Conferences for People Who Use Drugs Hospitalized With Complex Infections - Report - MDSpire
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OPTIONS-DC: Treatment Course Outcomes Following Outpatient Parenteral Antimicrobial Therapy RN–Led Multidisciplinary Care Conferences for People Who Use Drugs Hospitalized With Complex Infections
OPTIONS-DC: RN-Led Multidisciplinary Conferences Improve OPAT Outcomes in PWUD
Overview
The OPTIONS-DC program, a nurse-led multidisciplinary conference for hospitalized individuals with substance use disorders (SUD) requiring long-term IV antimicrobials, demonstrated high treatment completion rates over four years. Among 202 patients, 75.1% completed their antimicrobial course, with over half completing treatment outpatient, highlighting the program's effectiveness in complex discharge planning.
Background
Hospitalized patients with SUD often face stigma and logistical challenges that complicate discharge planning for serious infections requiring prolonged intravenous antimicrobial therapy. Traditional concerns include risks of line misuse and treatment nonadherence, leading to prolonged hospital stays or premature discharge. Harm reduction approaches and multidisciplinary collaboration are emerging strategies to address these barriers. OPTIONS-DC was developed to incorporate these principles, focusing on patient preferences, ethical considerations, and coordinated care to improve outcomes.
Data Highlights
Parameter
Value
Number of conferences conducted
229
Number of unique patients
202
Median conference length (minutes)
28 (IQR 23.8–33.0)
Median patient age (years)
38
Patients with active substance use (%)
93.5%
Patients experiencing homelessness (%)
33.6%
Median recommended antimicrobial duration (weeks)
6 (IQR 4–6)
Patients completing antimicrobial course (%)
75.1%
Completion inpatient (%)
46.5%
Completion outpatient (%)
53.5%
Average out-of-hospital antimicrobial days
28.7 (SD 19.6)
Odds ratio for treatment completion with primary care provider
4.50 (95% CI 1.55–13.07; P < .01)
Key Findings
OPTIONS-DC conferences were conducted for 202 unique patients with complex infections and substance use history over four years.
75.1% of patients completed their antimicrobial treatment course, with 53.5% completing treatment as outpatients.
Median antimicrobial duration was six weeks, with an average of 28.7 days of outpatient therapy.
Having an established primary care provider at the time of conference significantly increased odds of treatment completion (OR 4.50).
One-third of patients were experiencing homelessness, highlighting the program's reach to vulnerable populations.
The nurse-led multidisciplinary approach incorporated harm reduction and patient preferences to address stigma and logistical barriers.
Clinical Implications
The OPTIONS-DC model demonstrates that structured, nurse-led multidisciplinary conferences can effectively support complex discharge planning for PWUD requiring long-term IV antimicrobials. Incorporating harm reduction and patient-centered approaches facilitates outpatient treatment completion, even among vulnerable populations such as those experiencing homelessness. Ensuring linkage to primary care may further improve treatment adherence and outcomes.
Conclusion
OPTIONS-DC is associated with high antimicrobial treatment completion rates and successful outpatient therapy among hospitalized individuals with substance use disorders. This approach offers a promising framework to address the challenges of managing complex infections in this population.
by Alyse H Douglass, Heather Mayer, Kathleen Young, Amber C Streifel, Heather Franklin, Jina T Makadia, Liz Parkes-Perret, Luke C Strnad, Monica K Sikka
A large audit of biomedical publications suggests fabricated references are increasingly appearing in peer-reviewed papers — often in ways that are difficult for reviewers and readers to detect.
