title: Challenges of antibiotic prescribing for assisted living residents: perspectives of providers, staff, residents, and family members.
abstract: OBJECTIVE
  To better understand the antibiotic prescribing process in assisted living (AL) communities given the growing rate of antibiotic resistance.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Four AL communities in North Carolina.
  
  
  METHODS
  Assisted living residents who received antibiotics (n = 30) from October 20, 2010, to March 31, 2011, a primary family member, staff, and the prescribing medical provider.
  
  
  METHODS
  Semistructured interviews that were conducted regarding prescribing included the information available at the time of prescribing and the perceptions of the quality of communication between providers, staff, residents and family members about the resident. Providers were asked an open-ended question regarding how to improve the communication process related to antibiotic prescribing for AL residents.
  
  
  RESULTS
  For the 30 residents who received antibiotic prescriptions, providers often had limited information about the case and lacked familiarity with the residents, the residents' families, and staff. They also felt that cases were less severe and less likely to require an antibiotic than did residents, families, and staff. Providers identified several ways to improve the communication process, including better written documentation and staff and family presence.
  
  
  CONCLUSIONS
  In a small sample of AL communities, providers faced an array of challenges in making antibiotic prescribing decisions. This work confirms the complex nature of antibiotic prescribing in AL communities and indicates that further work is needed to determine how to improve the appropriateness of antibiotic prescribing.
authors: Department of Family Medicine, University of North Carolina, Chapel Hill, NC 27599, USA. christine_kistler@med.unc.edu
authors: Christine E
authors: CE
authors: Kistler
authors: Philip D
authors: PD
authors: Sloane
authors: Timothy F
authors: TF
authors: Platts-Mills
authors: Anna S
authors: AS
authors: Beeber
authors: Christine
authors: C
authors: Khandelwal
authors: David J
authors: DJ
authors: Weber
authors: C Madeline
authors: CM
authors: Mitchell
authors: David
authors: D
authors: Reed
authors: Latarsha
authors: L
authors: Chisholm
authors: Sheryl
authors: S
authors: Zimmerman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D040561:Assisted Living Facilities / Q000458:organization & administration*; D001291:Attitude of Health Personnel; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D010358:Patient Participation; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011368:Professional-Family Relations; D036301:Qualitative Research; D011785:Quality Assurance, Health Care
chemical_list: D000900:Anti-Bacterial Agents