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

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This is an author's peer-reviewed final manuscript, as accepted by the publisher. The published article is copyrighted by Elsevier and can be found at:  http://www.journals.elsevier.com/journal-of-pain-and-symptom-management/.

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  • 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.
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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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  • description.provenance : Approved for entry into archive by Deanne Bruner(deanne.bruner@oregonstate.edu) on 2013-12-12T00:25:13Z (GMT) No. of bitstreams: 1 FurunoJonPharmacyNationwideAnalysisAntibiotic.pdf: 429696 bytes, checksum: 82150a4796541bc98a72796151799d43 (MD5)
  • description.provenance : Made available in DSpace on 2013-12-12T00:25:13Z (GMT). No. of bitstreams: 1 FurunoJonPharmacyNationwideAnalysisAntibiotic.pdf: 429696 bytes, checksum: 82150a4796541bc98a72796151799d43 (MD5) Previous issue date: 2013-10
  • description.provenance : Submitted by Deanne Bruner (deanne.bruner@oregonstate.edu) on 2013-12-12T00:20:15Z No. of bitstreams: 1 FurunoJonPharmacyNationwideAnalysisAntibiotic.pdf: 429696 bytes, checksum: 82150a4796541bc98a72796151799d43 (MD5)

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