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A Nationwide Analysis of Antibiotic Use in Hospice Care in the Final Week of Life 公开 Deposited

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https://ir.library.oregonstate.edu/concern/articles/3n204023m

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Abstract
  • Context: Antibiotic prescribing in hospice patients is complicated by the focus on palliative rather than curative care and concerns regarding increasing antibiotic resistance. Objective: To estimate antibiotic use in a national sample of hospice patients and identify facility and patient characteristics associated with antibiotic use in this population. Methods: This was an analysis of data from the 2007 National Home and Hospice Care Survey, a nationally-representative sample of U.S. hospice agencies. We included data from 3,884 patients who died in hospice care. Our primary outcome measure was prevalence of antibiotic use in the last 7 days of life. Diagnoses, including potential infectious indications for antibiotic use, were defined using International Classification of Diseases, Ninth Revision (ICD-9) codes. Chi-square tests and t-tests were used to quantify associations of patient and facility characteristics with antibiotic use. Results: During the last 7 days of life, 27% (95% confidence interval (CI); 24%, 30%) of patients received at least one antibiotic and 1.3% (95% CI; 0.7%, 2.0%) received ≥ 3 antibiotics. Among patients who received at least one antibiotic, 15% (95% CI; 10%, 20%) had a documented infectious diagnosis, compared with 9% (95% CI; 7%, 11%) who had an infectious diagnosis but received no antibiotics. Conclusions: In this nationally-representative sample, 27% of hospice patients received an antibiotic during the last 7 days of life, most without a documented infectious diagnosis. Further research is needed to elucidate the role of antibiotics in this patient population to maintain palliative care goals while reducing unnecessary antibiotic use.
  • Keywords: Infection, Hospice, NHHCS (National Home and Hospice Care Survey), Antibiotics
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  • Albrecht, J. S., McGregor, J. C., Fromme, E. K., Bearden, D. T., & Furuno, J. P. (2013). A nationwide analysis of antibiotic use in hospice care in the final week of life. Journal of Pain and Symptom Management, 46(4), 483-490. doi:10.1016/j.jpainsymman.2012.09.010
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  • 46
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  • 4
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  • Financial Support: This work was supported by Agency for Healthcare Research and Quality grant R36HS021068-01 (J.S.A) and National Institutes of Health grants KL2RR024141 (J.C.M.), K07CA109511 (E.K.K.), and K01AI071015-05 (J.P.F.).
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