Mind the OPAT Gap: Providing Home Intravenous Antibiotic Therapy for Veterans Hospitalized at Community Hospitals

This is the authors' abstract. We don't add key points for this paper.

To the Editor—Responses to the 2020 Survey of Antimicrobial Stewardship at the Veterans Health Administration (VHA) [1] outlined many areas of expansive improvement in antimicrobial stewardship programs within VHA, as well as ongoing needs especially regarding outpatient parenteral antimicrobial therapy (OPAT). We believe these data provide important new insights into a process that affects veterans and their infectious diseases (ID) providers, including pharmacists and physicians, within VHA and non-VHA facilities. We also believe we are in a unique position to discuss these data as frontline providers of OPAT services to veterans at Veterans Affairs (VA) North Texas Health Care System, one of the largest health systems within VHA. ID consultation before OPAT prescription promotes antimicrobial stewardship and is associated with improved patient outcomes [2, 3], and ID physicians at VHA facilities approve 82% of individual patient OPAT orders and the antimicrobial stewardship team (physician or pharmacist) monitors and/or supervises 77% of OPAT patients [1]. However, VHA ID providers are often asked to arrange OPAT services for veterans hospitalized at non-VHA facilities relying primarily on the recommendations of their community ID colleagues. Often VHA ID practitioners do not have the opportunity to directly assess the patient and must rely on review of records, which may be incomplete or biased. The recent Survey of Antimicrobial Stewardship in the VHA captures the heterogeneous approaches adopted for managing these requests. Among respondents from 103 VHA facilities that were queried, 50% agree to supply medications prescribed by the community ID provider without requiring the patient’s face-to-face contact with VHA providers, and 75% do not require scheduling into an outpatient VHA clinic prior to approval. Twenty-two percent of respondents required inpatient transfer to their VHA facility. The survey also documents use of primary care physician-led prescription of antimicrobial agents with peripheral infectious disease support (Table 1).