Assessing Antibiotic Use in Hemodialysis Facilities across Arizona

Abstract

Specific Aims: Identify challenges that prevent Arizona HD facilities from obtaining necessary labs for the treatment of infectious diseases and the impact this has on their ability to provide optimal outpatient antibiotic therapy. Methods: This cross-sectional observational study will be done in collaboration with the Arizona Department of Health Services. Prospective data will be obtained via an on-line Qualtrics survey consisting of 15 questions determining barriers that prevent appropriate antibiotic therapy. Such as if the facility has an antibiotic stewardship program, as well as what barriers the facility faces when supplying antibiotic therapy. Participants will be recruited from Medicare-certified outpatient hemodialysis centers located within the state of Arizona. To be eligible, the facility must administer antibiotics. Results: Of the 130 outpatient hemodialysis facilities in Arizona, 46 consented to participate. 23 out of the 46 participants answered yes to having a designated leader for antimicrobial stewardship. 21 participants answered yes to tracking adverse drug events related to antibiotics. Participants reported the handoff of antibiotic treatment plans from other facilities as the most common barrier to outpatient treatment. It was selected 15 times. Access to antibiotics was the second most common, with 11 participants reporting that as a barrier to treatment. Conclusions: There is an opportunity for improved antimicrobial stewardship in outpatient hemodialysis facilities. Lack of communication between outside providers and hemodialysis facilities is a barrier to care. Improved processes around insurance reimbursement of antimicrobial agents and labs needed for follow-up monitoring would improve patient care.