Clinical Scorecard: Effects of Substance Use Disorders on the Outcomes of Medically Insured Patients Undergoing Extended Outpatient Parenteral Antimicrobial Therapy: A Claims-Based Analysis from 2015 to 2020

At a Glance

Key Highlights

• Patients with SUD had higher unadjusted 90-day readmission (40.1% vs 32.5%) and overdose rates (1.2% vs 0.1%) compared to non-SUD patients.
• Adjusted analyses showed SUD was not significantly associated with increased readmission or CVC event risk but was strongly associated with higher overdose risk (OR 6.03, P < .001).
• Readmission risk was influenced by insurance type, mental health disorders, and infection type; CVC events were linked to infection type and discharge disposition.

Guideline-Based Recommendations

Diagnosis

• Identify SUD using ICD-10-CM codes prior to discharge.
• Exclude patients with end-stage renal disease or Clostridioides difficile infection to avoid confounding.

Management

• Do not withhold OPAT solely based on SUD status.
• Consider harm reduction approaches to mitigate overdose risk in patients with SUD receiving OPAT.
• Use prolonged IV antibacterial therapy with appropriate monitoring for infections commonly caused by Gram-positive bacteria.

Monitoring & Follow-up

• Monitor for overdose events especially in patients with SUD during and after OPAT.
• Track central venous catheter-related complications regardless of SUD status.
• Assess for readmission risk factors including mental health disorders and insurance type.

Risks

• Increased risk of drug overdose in patients with SUD undergoing OPAT.
• Similar risk of central venous catheter events between patients with and without SUD.
• Potential for higher readmission rates in unadjusted analyses among SUD patients, but not significant after adjustment.

Patient & Prescribing Data

Medically insured adults receiving outpatient IV antibacterial therapy post-hospitalization, including 18% with documented SUD.

OPAT outcomes such as readmission and catheter complications are comparable between SUD and non-SUD patients after adjustment; overdose risk remains elevated in SUD.

Clinical Best Practices

• Avoid exclusion of patients with SUD from OPAT programs based solely on substance use history.
• Implement harm reduction strategies to address overdose risk during OPAT in patients with SUD.
• Consider patient-specific factors such as mental health and insurance status when planning post-discharge care.
• Ensure thorough documentation and coding of SUD to guide risk stratification and management.

References

• Substance Use Disorder prevalence and injection drug use trends
• Infectious complications related to injection drug use
• OPAT guidelines and management considerations