Impact of ID Pharmacist OPAT Plan Reconciliation on 90-Day Healthcare Utilization

Overview

Implementation of infectious diseases (ID) pharmacist-led reconciliation of outpatient parenteral antimicrobial therapy (OPAT) plans prior to hospital discharge significantly reduced 90-day emergency department visits and hospital readmissions. No significant difference was observed in 90-day all-cause mortality between pre- and postimplementation cohorts.

Background

Outpatient parenteral antimicrobial therapy (OPAT) enables intravenous antimicrobial treatment outside the hospital, offering benefits such as shorter hospital stays and reduced healthcare costs. However, OPAT carries risks including adverse drug events and complications related to vascular access, which can lead to unscheduled healthcare utilization. Medication reconciliation by pharmacists during care transitions is a recognized strategy to reduce medication errors and associated unplanned healthcare visits. Prior to this study, the effect of ID pharmacist reconciliation of OPAT plans on subsequent healthcare utilization had not been evaluated.

Data Highlights

Key Findings

• Postimplementation patients had significantly fewer 90-day emergency department visits (17.8% vs 22.2%, P = .02).
• Hospital readmissions within 90 days were significantly reduced postimplementation (33.4% vs 38.9%, P = .01).
• No significant difference was found in 90-day all-cause mortality between pre- and postimplementation groups.
• ID pharmacists conducted OPAT plan reconciliation prior to discharge, including antimicrobial optimization and monitoring recommendations.
• The intervention required approximately 0.2 full-time equivalent effort, or 8 hours per week.

Clinical Implications

Incorporating ID pharmacist-led OPAT plan reconciliation prior to hospital discharge can effectively reduce unscheduled healthcare utilization, specifically emergency department visits and readmissions, within 90 days. This intervention supports safer transitions of care for patients receiving OPAT without increasing mortality risk. Healthcare systems should consider implementing pharmacist-driven reconciliation protocols to optimize OPAT safety and outcomes.

Conclusion

Standardized reconciliation of OPAT plans by infectious diseases pharmacists prior to discharge is associated with significant reductions in 90-day emergency department visits and hospital readmissions, enhancing patient safety during transitions of care. This approach represents a valuable strategy to improve outcomes for OPAT recipients.

References

1. Infectious Diseases Society of America OPAT Guidelines 2018 -- Recommendations for OPAT management
2. UMMC Study 2023 -- Analysis of Propensity Score Weighting on OPAT Plan Reconciliation Effects