Abstract Background Unplanned healthcare utilization events, including hospital readmissions and emergency room (ER) visits, are common in patients receiving outpatient parenteral antimicrobial therapy (OPAT). Little is known about patient adherence to therapy in this setting. This clinical trial evaluates the impact of a remote therapeutic monitoring (RTM) device with an integrated care platform on all-cause healthcare utilization in patients on OPAT. Methods This prospective, open-label, non-randomized study enrolled patients discharged on OPAT to receive the IV Ensure RTM device compared to contemporaneous controls. The primary outcome was all-cause healthcare utilization, including hospital readmission or ER visit, assessed at day 90 post-discharge. Adherence to antimicrobial therapy was evaluated in the intervention group. Results A total of 81 patients were enrolled in the intervention and 131 patients constituted the control group. Both groups had similar baseline and OPAT characteristics. On multivariate Cox regression analysis, the RTM intervention was associated with a 39% reduction in all-cause healthcare utilization by day 60 (aHR 0.61, 95% CI 0.38-0.96, p=0.030) and a 38% reduction by day 90 (aHR 0.62, 95% CI 0.40-0.95, p=0.027). In the intervention group, the overall adherence reached a median of 94%, and 61.7% of patients maintained an adherence > 90% throughout their OPAT course. Conclusions An RTM device with an integrated care platform significantly reduced all-cause healthcare utilization events in patients on OPAT.