629 - Understanding the Effects of Social Determinants of Health on Outcome When Discharging Veterans on Parenteral Antibiotic Therapy

Background: Social determinants of health are conditions in which people live, including aspects of both social environments and physical environments, and how these conditions affect their health. Examples of social determinants include access to health care, social support, culture, etc. These factors are often considered when discharging a patient on IV antibiotics. The purpose of this study was to determine if social determinants of health are related to outcomes for veterans discharged from the Zablocki VA on outpatient parenteral antibiotic therapy (OPAT).

Methods: This retrospective chart review evaluated veterans discharged home from the Zablocki VA on OPAT between the years of 2013 and 2017. Variables of social determinants of health included: race/ethnicity, co-habitants, mental health diagnosis, employment, use of illicit drugs, use of tobacco, and use of alcohol. The primary outcome analyzed was completion of therapy with or without complication. Complication is defined as antibiotic change/dose adjustment, PICC line complication, or additional clinic/hospital visit.

Results: Overall, 294 veterans’ charts were reviewed. Of these patients, 188 (63.95%) had no complication and 106 (36.05%) had a complication. Univariate analyses of social determinants are summarized in Table 1. Tobacco use was the only factor significantly associated with OPAT complication (p= 0.008).Table 1.


Conclusion: This analysis suggests that many social determinants thought to potentially impact OPAT outcomes, such as race/ethnicity, co-inhabitants, mental health diagnosis, employment status, and use of illicit drugs or alcohol were not significant contributions to OPAT complications in the Milwaukee VA population; although, veterans who were current smokers were more likely to have an OPAT complication. These results may speak to the VA’s integral social support provided to veterans upon discharge, and perhaps, the above social determinants should not be as heavily considered when deciding if a veteran can perform OPAT. However, it is important to consider that these results may reflect the careful selection of Milwaukee veterans discharged on OPAT, as questionable cases can be treated as an inpatient.