Date of Award

1-1-2019

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Manisha Juthani-Mehta

Abstract

Introduction Outpatient parenteral antimicrobial therapy (OPAT) is considered practical, safe, and cost-effective, but roughly 20% of all adult patients on OPAT experience an adverse event (AE). Frequency of AEs and healthcare utilization, defined as emergency department visits and infectious disease office visits, phone calls, and emails, may be greatest in the first two weeks of OPAT. Given that older adults (age ≥ 65) have greater cognitive decline, ADL limitations, and comorbidities than younger adults, we sought to evaluate the frequency and timing of AEs in older adults on OPAT. We examine patients on OPAT at Yale New Haven Hospital (YNHH) under the hypotheses that 1) older adults will have a greater frequency of AEs and healthcare utilization than younger adults, and 2) older adults will have AEs earlier than younger adults.

Methods We collected all data from the electronic medical record system, Epic, for YNHH. On 505 probable OPAT courses flagged and abstracted from Epic from October 2016 through September 2017, we reviewed medical records to assess patient, infection, and OPAT characteristics, as well as AEs and healthcare utilization. Data analysis on 457 unique OPAT courses ≤100 days was conducted using SAS, R, and SaTScan.

Results Older and younger adults did not significantly differ in the frequency of OPAT-specific AEs (unadjusted IRR=0.91 [0.60, 1.37], adjusted OR=0.98 [0.61, 1.57]) or frequency of healthcare utilization (IRR=1.09 [0.90, 1.33]). Older adults have the greatest risk of OPAT-specific AEs from days 4-15 after discharge (p=0.01), and younger adults’ greatest risk is from days 5-25 (p=0.03).

Conclusion Older adults do not significantly differ in OPAT-specific AEs and healthcare utilization compared to younger adults. Older adults seem to have a more specific risk period, so more attention may be necessary during this time. OPAT remains a safe option for older adults.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 08/28/2021

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