A nationwide analysis of antibiotic use in hospice care in the final week of life

Jennifer S. Albrecht, Jessina C. McGregor, Erik Fromme, David T. Bearden, Jon P. Furuno

    Research output: Contribution to journalArticle

    35 Citations (Scopus)

    Abstract

    Context: Antibiotic prescription in hospice patients is complicated by the focus on palliative rather than curative care and concerns regarding increasing antibiotic resistance. Objectives: To estimate the 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 3884 patients who died in hospice care. The primary outcome measure was prevalence of antibiotic use in the last seven days of life. Diagnoses, including potential infectious indications for antibiotic use, were defined using International Classification of Diseases, Ninth Revision (ICD-9) codes. Chi-squared tests and t-tests were used to quantify associations of patient and facility characteristics with antibiotic use. Results: During the last seven days of life, 27% (95% CI: 24%-30%) of patients received at least one antibiotic and 1.3% (95% CI: 0.7%-2.0%) received three or more 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. Conclusion: In this nationally representative sample, 27% of hospice patients received an antibiotic during the last seven 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.

    Original languageEnglish (US)
    Pages (from-to)483-490
    Number of pages8
    JournalJournal of Pain and Symptom Management
    Volume46
    Issue number4
    DOIs
    StatePublished - Oct 2013

    Fingerprint

    Hospice Care
    Anti-Bacterial Agents
    Hospices
    International Classification of Diseases
    Home Care Services
    Microbial Drug Resistance
    Palliative Care
    Population
    Prescriptions

    Keywords

    • antibiotics
    • Hospice
    • infection
    • NHHCS

    ASJC Scopus subject areas

    • Anesthesiology and Pain Medicine
    • Clinical Neurology
    • Nursing(all)

    Cite this

    A nationwide analysis of antibiotic use in hospice care in the final week of life. / Albrecht, Jennifer S.; McGregor, Jessina C.; Fromme, Erik; Bearden, David T.; Furuno, Jon P.

    In: Journal of Pain and Symptom Management, Vol. 46, No. 4, 10.2013, p. 483-490.

    Research output: Contribution to journalArticle

    Albrecht, Jennifer S. ; McGregor, Jessina C. ; Fromme, Erik ; Bearden, David T. ; Furuno, Jon P. / A nationwide analysis of antibiotic use in hospice care in the final week of life. In: Journal of Pain and Symptom Management. 2013 ; Vol. 46, No. 4. pp. 483-490.
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    abstract = "Context: Antibiotic prescription in hospice patients is complicated by the focus on palliative rather than curative care and concerns regarding increasing antibiotic resistance. Objectives: To estimate the 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 3884 patients who died in hospice care. The primary outcome measure was prevalence of antibiotic use in the last seven days of life. Diagnoses, including potential infectious indications for antibiotic use, were defined using International Classification of Diseases, Ninth Revision (ICD-9) codes. Chi-squared tests and t-tests were used to quantify associations of patient and facility characteristics with antibiotic use. Results: During the last seven days of life, 27{\%} (95{\%} CI: 24{\%}-30{\%}) of patients received at least one antibiotic and 1.3{\%} (95{\%} CI: 0.7{\%}-2.0{\%}) received three or more 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. Conclusion: In this nationally representative sample, 27{\%} of hospice patients received an antibiotic during the last seven 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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