title: Frequency of outpatient antibiotic prescription on discharge to hospice care.
abstract: The use of antibiotics is common in hospice care despite limited evidence that it improves symptoms or quality of life. Patients receiving antibiotics upon discharge from a hospital may be more likely to continue use following transition to hospice care despite a shift in the goals of care. We quantified the frequency and characteristics for receiving a prescription for antibiotics on discharge from acute care to hospice care. This was a cross-sectional study among adult inpatients (≥18 years old) discharged to hospice care from Oregon Health & Science University (OHSU) from 1 January 2010 to 31 December 2012. Data were collected from an electronic data repository and from the Department of Care Management. Among 62,792 discharges, 845 (1.3%) patients were discharged directly to hospice care (60.0% home and 40.0% inpatient). Most patients discharged to hospice were >65 years old (50.9%) and male (54.6%) and had stayed in the hospital for ≤7 days (56.6%). The prevalence of antibiotic prescription upon discharge to hospice was 21.1%. Among patients discharged with an antibiotic prescription, 70.8% had a documented infection during their index admission. Among documented infections, 40.3% were bloodstream infections, septicemia, or endocarditis, and 38.9% were pneumonia. Independent risk factors for receiving an antibiotic prescription were documented infection during the index admission (adjusted odds ratio [AOR]=7.00; 95% confidence interval [95% CI]=4.68 to 10.46), discharge to home hospice care (AOR=2.86; 95% CI=1.92 to 4.28), and having a cancer diagnosis (AOR=2.19; 95% CI=1.48 to 3.23). These data suggest that a high proportion of patients discharged from acute care to hospice care receive an antibiotic prescription upon discharge.
authors.affiliation: Department of Pharmacy Practice, Oregon State University/Oregon Health & Science University College of Pharmacy, Portland, Oregon, USA furuno@ohsu.edu.
authors.forename: Jon P
authors.initials: JP
authors.lastname: Furuno
authors.affiliation: Department of Pharmacy Practice, Oregon State University/Oregon Health & Science University College of Pharmacy, Portland, Oregon, USA.
authors.forename: Brie N
authors.initials: BN
authors.lastname: Noble
authors.affiliation: Department of Care Management, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Kristi N
authors.initials: KN
authors.lastname: Horne
authors.affiliation: Department of Pharmacy Practice, Oregon State University/Oregon Health & Science University College of Pharmacy, Portland, Oregon, USA.
authors.forename: Jessina C
authors.initials: JC
authors.lastname: McGregor
authors.affiliation: Department of Pharmacy Practice, Oregon State University/Oregon Health & Science University College of Pharmacy, Portland, Oregon, USA.
authors.forename: Miriam R
authors.initials: MR
authors.lastname: Elman
authors.affiliation: Department of Pharmacy Practice, Oregon State University/Oregon Health & Science University College of Pharmacy, Portland, Oregon, USA.
authors.forename: David T
authors.initials: DT
authors.lastname: Bearden
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA Palliative Care Service, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Walsh
authors.affiliation: Palliative Care Service, Oregon Health & Science University, Portland, Oregon, USA Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Erik K
authors.initials: EK
authors.lastname: Fromme
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D017051:Hospice Care / Q000379:methods / Q000706:statistics & numerical data*; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D007297:Inpatients; D008297:Male; D010045:Outpatients / Q000706:statistics & numerical data*; D015995:Prevalence; D011788:Quality of Life; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents