From the 2018 HVPAA National Conference
Anisha Ganguly (University Texas Southwestern Medical School), Larry Brown (Parkland Health and Hospital System), John Watkins (Parkland Center for Clinical Innovation), Vibin Roy (Parkland Center for Clinical Innovation), Kristin S. Alvarez (Parkland Health and Hospital System), Deepak Agrawal (University Texas Southwestern Medical Center), Kavita Bhavan (University)
Diabetes is common among patients in the Self-administered outpatient parenteral antimicrobial therapy (S-OPAT) program. Previous research has shown that engaging in self-care activates patient and thus improves outcomes of chronic diseases. Given the degree of patient activation demanded by the S-OPAT program, we hypothesized that S-OPAT may improve diabetes outcomes.
To determine if patient engagement through self-administration of IV antibiotics is associated with improved diabetes self-care
We conducted a before-after retrospective analysis of diabetic patients receiving S-OPAT. Diabetic patients were defined as having a HgbA1c >6.7 in the 6 months prior to initiation of S-OPAT. Outcomes were compared between the 6 month-period prior to and the 6-month period following initiation of S-OPAT. Outcomes of diabetes self-management included HgbA1c, diabetes medication adherence (as measured by proportion of days covered, or PDC), and use of any diabetes medication. A sub-group HgbA1c analysis was conducted among insulin users. Difference in outcome was tested for significance using paired t-tests.
A total of 348 patients were identified for inclusion in the diabetes S-OPAT. The mean HgbA1c decreased by 1.82 from the 6 months prior to the 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 adherence rates to diabetes medications or initiation of medications pre and post-initiation of S-OPAT (p > 0.05). There was no significant change in the type or number of medications prescribed to these patients suggesting that the improvement was largely driven by improved self-care.
Initiation of S-OPAT was associated with a significant reduction in HgbA1c among diabetic patients. It is likely that the degree of patient engagement obtained through the S-OPAT model yields collateral benefits in other aspects of self-care, including glycemic control.
Implications for the Patient
Teaching models utilized in the Parkland S-OPAT program may have important implications for fostering patient engagement in clinical care beyond self-administered antimicrobial therapy. In appropriate settings, self-care is the effective and efficient model of health care.