Date of Award

Fall 12-2018

Degree Name

Master of Public Health (MPH)

Advisor(s)

BIJAL BALASUBRAMANIAN, MBBS, PHD

Second Advisor

KAVITA BHAVAN, MD, MHS

Abstract

Self-administered outpatient parenteral antimicrobial therapy (S-OPAT) is a self-care treatment modality in which patients requiring extended courses of intravenous antibiotics are trained to safely self-administer treatment via an indwelling catheter in their home. Many patients seen in the S-OPAT program have a diagnosis of diabetes and present with infections associated with poor glycemic control, including skin and soft-tissue infections and osteomyelitis. Given the degree of patient activation required to successfully complete the S-OPAT process, we hypothesized that participation in this self-care program may benefit patients in self-management of other chronic health conditions, such as diabetes. The study team included Anisha Ganguly (MPH candidate), Larry Brown (biostatistician), David Watkins, Dr. Kristin Alvarez, Dr. Deepak Agrawal, and Dr. Kavita Bhavan, founder and director of the Parkland S-OPAT clinic. We conducted a before-after retrospective analysis of diabetic patients receiving S-OPAT. HgbA1c, diabetes medication refill rates, and changes to diabetes medication regimen were compared in 6-month intervals prior to and following initiation of S-OPAT. A total number of 348 diabetic patients were identified, and 206 diabetic patients were included in the analysis. The mean HgbA1c decreased by 1.82 from the time period 6 months prior to and 6 months after initiation of S-OPAT (p < 0.001). Subgroup analysis showed an additional significant reduction in HgbA1c among insulin users (p = 0.002). There were no differences in refill rates of diabetes medications or changes in medication regimen pre- and post-initiation of S-OPAT (p > 0.05). Initiation of S-OPAT was associated with a significant reduction in HgbA1c among diabetic patients with similar findings among insulin users, a group requiring a higher level of self-care. The degree of patient engagement obtained through the S-OPAT model may have collateral benefits in improved self-management of other chronic diseases such as diabetes.

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