Challenges of Antibiotic Prescribing for Assisted Living Residents: Perspectives of Providers, Staff, Residents, and Family Members

Authors

  • Christine E. Kistler MD, MASc,

    Corresponding author
    1. Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
    • Department of Family Medicine, University of North Carolina, Chapel Hill, North Carolina
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  • Philip D. Sloane MD, MPH,

    1. Department of Family Medicine, University of North Carolina, Chapel Hill, North Carolina
    2. Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
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  • Timothy F. Platts-Mills MD,

    1. Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina
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  • Anna S. Beeber PhD, RN,

    1. Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
    2. School of Nursing, University of North Carolina, Chapel Hill, North Carolina
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  • Christine Khandelwal DO,

    1. Department of Family Medicine, University of North Carolina, Chapel Hill, North Carolina
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  • David J. Weber MD, MPH,

    1. Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
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  • C. Madeline Mitchell MURP,

    1. Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
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  • David Reed PhD,

    1. Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
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  • Latarsha Chisholm PhD,

    1. Department of Health Management and Informatics, University of Central Florida, Orlando, Florida
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  • Sheryl Zimmerman PhD

    1. Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
    2. School of Social Work, University of North Carolina, Chapel Hill, North Carolina
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Address correspondence to Christine E. Kistler, University of North Carolina, 590 Manning Drive, CB #7595, Chapel Hill, NC 27599. E-mail: christine_kistler@med.unc.edu

Abstract

Objectives

To better understand the antibiotic prescribing process in assisted living (AL) communities given the growing rate of antibiotic resistance.

Design

Cross-sectional survey.

Setting

Four AL communities in North Carolina.

Participants

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.

Measurements

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.

Conclusion

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.

Ancillary