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Rodrigues I, Ribeiro H, Costa C, Rocha-Neves J, Dourado M. Pharmacological Prescription at the End of Life: Quality Assessment in the Transition of Care to a Community Palliative Care Support Team. Pharmaceutics 2024; 16:1152. [PMID: 39339189 PMCID: PMC11434967 DOI: 10.3390/pharmaceutics16091152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 08/27/2024] [Accepted: 08/29/2024] [Indexed: 09/30/2024] Open
Abstract
Appropriate pharmacological management is a cornerstone of quality in palliative care (PC), focusing on comfort and quality of life. Therapeutic review is crucial in PC, aiming to optimize symptom relief, reduce adverse effects, and manage drug interactions. This study aims to delve into the real-world pharmacological prescription practices within a Community Palliative Care Support Team (CPCST) in the northern region of Portugal, comparing practices at admission and at the last consultation before death. It is an observational, cross-sectional, retrospective study without intervention involving patients admitted to a CPCST in 2021. Data were obtained from clinical records, and the statistical analysis included descriptive and inferential measures. Sixty-four patients were included, with an average age of 77.34 years, referred mainly by a specialized Hospital Palliative Care Support Team (65.63%). Polypharmacy was present, with a significant increase in opioids, antipsychotics, prokinetics, antiemetics, antispasmodics, and local corticosteroids, and a reduction in drugs for peptic ulcer and gastroesophageal reflux treatment, antithrombotics, hypolipidemics, antihypertensives, and antidiabetics, among others. The oral route was preferred, decreasing between the two analyzed moments (85.5% versus 49.1%). Pro re nata (PRN) medications increased significantly (p ≤ 0.001). The prescription profile reflects a focus on symptom relief. The deprescription of drugs for chronic comorbidities suggests adaptation to care goals. At the end of life, PRN medications increase significantly (1.34 versus 3.26, p ≤ 0.001), administered as needed to soothe fluctuating symptoms. The pharmacological classes that have significantly increased are relevant in alleviating common symptoms in PC. The use of alternative routes for medication administration increases as instability of the oral route occurs, leading to a reduction in orally administered medications. Among these alternatives, the subcutaneous route shows the largest increase. The findings underscore the importance of flexible and responsive medication strategies in end-of-life care.
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Affiliation(s)
- Inês Rodrigues
- Community Palliative Care Support Team Gaia, R. Bartolomeu Dias 316, 4430-043 Vila Nova de Gaia, Portugal
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Hugo Ribeiro
- Community Palliative Care Support Team Gaia, R. Bartolomeu Dias 316, 4430-043 Vila Nova de Gaia, Portugal
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology-Group of Environment Genetics and Oncobiology (CIMAGO), FMUC, 3004-304 Coimbra, Portugal
- Faculty of Medicine, University of Porto, 4200-219 Porto, Portugal
| | - Carolina Costa
- Faculty of Medicine, University of Porto, 4200-219 Porto, Portugal
- Barão do Corvo Family Health Unit, 4400-035 Vila Nova de Gaia, Portugal
| | - João Rocha-Neves
- Faculty of Medicine, University of Porto, 4200-219 Porto, Portugal
- RISE@Health, 4200-219 Porto, Portugal
| | - Marília Dourado
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology-Group of Environment Genetics and Oncobiology (CIMAGO), FMUC, 3004-304 Coimbra, Portugal
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Andrade A, Nascimento T, Cabrita C, Leitão H, Pinto E. Potentially Inappropriate Medication: A Pilot Study in Institutionalized Older Adults. Healthcare (Basel) 2024; 12:1275. [PMID: 38998810 PMCID: PMC11241476 DOI: 10.3390/healthcare12131275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 06/09/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Institutionalized older adults often face complex medication regimens, increasing their risk of adverse drug events due to polypharmacy, overprescribing, medication interactions, or the use of Potentially Inappropriate Medications (PIM). However, data on medication use and associated risks in this population remain scarce. This pilot study aimed to characterize the sociodemographic, clinical and pharmacotherapeutic profiles, and the use of PIM among institutionalized elders residing in Residential Structures for Elderly People (ERPI) in the Faro municipality, located in the Portuguese region of the Algarve. We conducted a cross-sectional study in a non-randomized sample of 96 participants (mean age: 86.6 ± 7.86 years) where trained researchers reviewed medication profiles and identified potentially inappropriate medications using the EU(7)-PIM list. Over 90% of participants exhibited polypharmacy (≥5 medications), with an average of 9.1 ± 4.15 medications per person. About 92% had potential drug interactions, including major and moderate interactions. More than 86% used at least one potentially inappropriate medication, most commonly central nervous system drugs. This pilot study demonstrates that institutionalized older adults may be at high risk of potential medication-related problems. Implementing comprehensive medication review programs and promoting adapted prescribing practices are crucial to optimize medication use and improve the well-being of this vulnerable population.
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Affiliation(s)
- Amanda Andrade
- Escola Superior de Saúde, Universidade do Algarve (ESSUAlg), Campus de Gambelas, Edifício 1, 8005-139 Faro, Portugal; (A.A.); (T.N.); (C.C.)
| | - Tânia Nascimento
- Escola Superior de Saúde, Universidade do Algarve (ESSUAlg), Campus de Gambelas, Edifício 1, 8005-139 Faro, Portugal; (A.A.); (T.N.); (C.C.)
- Algarve Biomedical Center Research Institute (ABC-RI), Universidade do Algarve, Campus de Gambelas, Edifício 2, 8005-139 Faro, Portugal;
| | - Catarina Cabrita
- Escola Superior de Saúde, Universidade do Algarve (ESSUAlg), Campus de Gambelas, Edifício 1, 8005-139 Faro, Portugal; (A.A.); (T.N.); (C.C.)
| | - Helena Leitão
- Algarve Biomedical Center Research Institute (ABC-RI), Universidade do Algarve, Campus de Gambelas, Edifício 2, 8005-139 Faro, Portugal;
- Faculdade de Medicina e Ciências Biomédicas, Universidade do Algarve, Campus de Gambelas, Edifício 2, 8005-139 Faro, Portugal
| | - Ezequiel Pinto
- Escola Superior de Saúde, Universidade do Algarve (ESSUAlg), Campus de Gambelas, Edifício 1, 8005-139 Faro, Portugal; (A.A.); (T.N.); (C.C.)
- Algarve Biomedical Center Research Institute (ABC-RI), Universidade do Algarve, Campus de Gambelas, Edifício 2, 8005-139 Faro, Portugal;
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Masumoto S, Hosoi T, Nakamura T, Hamano J. Polypharmacy and Potentially Inappropriate Medications in Patients With Advanced Cancer: Prevalence and Associated Factors at the End of Life. J Palliat Med 2024; 27:749-755. [PMID: 38354283 DOI: 10.1089/jpm.2023.0520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Background: Polypharmacy and potentially inappropriate medications (PIMs) impose a burden on patients with advanced cancer near the end of their lives. However, only a few studies have addressed factors associated with PIMs in such patients. Objective: To examine polypharmacy and factors associated with PIMs in end-of-life patients with advanced cancer. Design: Retrospective chart review. Setting/Subjects: We analyzed 265 patients with advanced cancer who died in a palliative care unit (PCU) or at home in a home medical care (HMC) from April 2018 to December 2022 in Japan. Measurements: Sociodemographic, clinical, and prescription data at the time of PCU admission or HMC initiation were collected from electronic medical records. PIMs were assessed using OncPal Deprescribing Guidelines. Results: Patients with advanced cancer with an average age of 76.3 years and median survival days of 20 were included in the analyses. The average number of medications was 6.4 (standard deviation = 3.4), and PIMs were prescribed to 50.2%. Frequent PIMs included antihypertensive medications, peptic ulcer prophylaxis, and dyslipidemia medications. A multivariate logistic regression analysis revealed that age ≥75 years (adjusted odds ratio [aOR] = 2.30, 95% confidence interval [CI] = 1.30-4.05), referral from an outpatient setting compared with inpatient setting (aOR = 2.06, 95% CI = 1.12-3.80), more than two comorbidities (aOR = 1.88, 95% CI = 1.08-3.29), and more than five medications (aOR = 1.84, 95% CI = 1.03-3.28) were associated with PIMs. Conclusions: Medication reconciliation is recommended at the time of transition to a PCU or HMC, especially for older patients with advanced cancer who were referred from an outpatient setting and present more comorbidities and prescriptions.
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Affiliation(s)
- Shoichi Masumoto
- Department of Family Medicine, General Practice and Community Health, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of General Medicine, Tsukuba Central Hospital, Ushiku, Ibaraki, Japan
| | - Takahiro Hosoi
- Department of General Medicine, Tsukuba Central Hospital, Ushiku, Ibaraki, Japan
| | - Toru Nakamura
- Department of Pharmacy, Tsukuba Central Hospital, Ushiku, Ibaraki, Japan
| | - Jun Hamano
- Department of Palliative and Supportive Care, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Tanuseputro P, Roberts RL, Milani C, Clarke AE, Webber C, Isenberg SR, Kobewka D, Turcotte L, Bush SH, Boese K, Arya A, Robert B, Sinnarajah A, Simon JE, Howard M, Lau J, Qureshi D, Fremont D, Downar J. Palliative End-of-Life Medication Prescribing Rates in Long-Term Care: A Retrospective Cohort Study. J Am Med Dir Assoc 2024; 25:532-538.e8. [PMID: 38242534 DOI: 10.1016/j.jamda.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Medications are often needed to manage distressing end-of-life symptoms (eg, pain, agitation). OBJECTIVES In this study, we describe the variation in prescribing rates of symptom relief medications at the end of life among long-term care (LTC) decedents. We evaluate the extent these medications are prescribed in LTC homes and whether prescribing rates of end-of-life symptom management can be used as an indicator of quality end-of-life care. DESIGN Retrospective cohort study using administrative health data. SETTING AND PARTICIPANTS LTC decedents in all 626 publicly funded LTC homes in Ontario, Canada, between January 1, 2017, and March 17, 2020. METHODS For each LTC home, we measured the percent of decedents who received 1+ prescription(s) for a subcutaneous end-of-life symptom management medication ("end-of-life medication") in their last 14 days of life. We then ranked LTC homes into quintiles based on prescribing rates. RESULTS We identified 55,916 LTC residents who died in LTC. On average, two-thirds of decedents (64.7%) in LTC homes were prescribed at least 1 subcutaneous end-of-life medication in the last 2 weeks of life. Opioids were the most common prescribed medication (overall average prescribing rate of 62.7%). LTC homes in the lowest prescribing quintile had a mean of 37.3% of decedents prescribed an end-of-life medication, and the highest quintile mean was 82.5%. In addition, across these quintiles, the lowest prescribing quintile had a high average (30.3%) of LTC residents transferred out of LTC in the 14 days compared with the highest prescribing quintile (12.7%). CONCLUSIONS AND IMPLICATIONS Across Ontario's LTC homes, there are large differences in prescribing rates for subcutaneous end-of-life symptom relief medications. Although future work may elucidate why the variability exists, this study provides evidence that administrative data can provide valuable insight into the systemic delivery of end-of-life care.
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Affiliation(s)
- Peter Tanuseputro
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada.
| | - Rhiannon L Roberts
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Christina Milani
- Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - Anna E Clarke
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Colleen Webber
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sarina R Isenberg
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - Daniel Kobewka
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Luke Turcotte
- Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Shirley H Bush
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - Kaitlyn Boese
- Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - Amit Arya
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Kensington Research Institute, Toronto, Ontario, Canada
| | - Benoit Robert
- Centre of Excellence in Frailty-Informed Care, Perley Health, Ottawa, Ontario, Canada
| | | | - Jessica E Simon
- Department of Oncology, Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jenny Lau
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Palliative Care, University Health Network, Toronto, Ontario, Canada
| | - Danial Qureshi
- Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - Deena Fremont
- Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - James Downar
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada
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Lee J, Han CY, Fox A, Crawford-Williams F, Joseph R, Yates P, Thamm C, Chan RJ. Are Australian Cancer and Palliative Care Nurses Ready to Prescribe Medicines? A National Survey. Semin Oncol Nurs 2024; 40:151578. [PMID: 38246841 DOI: 10.1016/j.soncn.2023.151578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVES Registered nurse prescribing has been put forth, for decades, as an innovative approach to meet growing healthcare needs, particularly in areas of care where medications are essential and highly controlled such as for patients requiring cancer and palliative care. However, the adoption of innovative health delivery models requires acceptance by key stakeholders. This study explores cancer and palliative care nurses' attitudes toward nurse prescribing and their perceptions about educational requirements for a nurse prescriber. DATA SOURCES A cross-sectional survey was distributed to Australian nurses between March and July 2021. Data were collected using the Advancing Implementation of Nurse Prescribing in Australia online survey. Pearson χ2 tests were used to examine associations between nurses in cancer care, palliative care, and all other specialties on demographics, attitudes to nurse prescribing, and educational perspectives to become prescribers. Of the 4,424 nurses who participated in the survey, 161 nurses identified they worked in cancer care and 109 in palliative care settings. CONCLUSION Although nurses have a common set of core capabilities, their work contexts and their professional experiences shape their attitudes toward practice. Nurses in cancer care were significantly less certain than nurses in palliative care [χ2(2) = 6.68, P = .04], and nurses from all other specialties [χ2(2) =13.87, P = <.01] of the benefits of nurse prescribing (ie, nurse prescribing would decrease health care system costs, reduce patient risk). Nurses in cancer care were more certain that successfully implementing nurse prescribing requires strong support from their medical and pharmacy colleagues. In addition, nurses working in cancer and palliative care agreed that improving patient care was their primary motivator for becoming a prescriber. IMPLICATIONS FOR NURSING PRACTICE Open to expanding their role and responsibilities, nurses in cancer and palliative care settings reported that successfully adopting nurse prescribing must be supported by their other healthcare colleagues within the same environment, which demands strong interprofessional collaborative efforts.
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Affiliation(s)
- Jane Lee
- Research Fellow, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Chad Yixian Han
- Research Fellow, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Amanda Fox
- Associate Professor, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia; Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia; and Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Fiona Crawford-Williams
- Research Fellow, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Ria Joseph
- Research Fellow, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Patsy Yates
- Executive Dean, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia; Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Carla Thamm
- Senior Research Fellow, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Raymond Javan Chan
- Deputy Vice Chancellor (Research), Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
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Pedrosa Carrasco AJ, Bezmenov A, Sibelius U, Berthold D. How Safe Do Dying People Feel at Home? Patients' Perception of Safety While Receiving Specialist Community Palliative Care. Am J Hosp Palliat Care 2023; 40:829-836. [PMID: 36396608 PMCID: PMC10333965 DOI: 10.1177/10499091221140075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND There is a research gap regarding safety concerns of patients at the end of life. The aim of this study was, therefore, to explore whether patients under specialist community palliative care feel safe at home and which factors affect the perceived safety. Furthermore, we investigated if perception of safety is associated with different aspects of subsequent care. METHODS Using a standardized questionnaire, a cross-sectional survey was conducted among 100 specialist community palliative care patients. Logistic regression was used to examine the strength of the association between clinical and socio-demographic variables and the perception of safety. After a 6-month follow-up period, we analyzed differences in various care-related outcomes between patients with unaffected and impaired perceptions of safety. RESULTS In our study, one in five patients receiving specialist community palliative care expressed safety concerns. Subdomains of safety that were reported most frequently were physical disability (60%), physical symptoms (30%), psychological symptoms (26%), and side effects/complications of drug therapy (19%). Of the participants surveyed after the initial COVID-19 lockdown, 35.1% reported that they felt their safety had been adversely affected by the pandemic. Compromised safety perception was associated with higher levels of palliative care-related problems, and proximity to death. CONCLUSIONS Our study uncovered relevant safety concerns of palliative care patients receiving specialist community palliative care. The insights gained into patient-reported problems may help healthcare professionals to identify situations where patients feel unsafe. Further research should address primary and secondary prevention measures to improve the quality of end-of-life care in the home environment.
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Affiliation(s)
- Anna J Pedrosa Carrasco
- Research Group Medical Ethics, Philipps-University Marburg, Marburg, Germany
- Department of Medical Oncology and Palliative Care, University Hospital of Giessen and Marburg, Giessen Site, Germany
| | - Alexandra Bezmenov
- Department of Medical Oncology and Palliative Care, University Hospital of Giessen and Marburg, Giessen Site, Germany
| | - Ulf Sibelius
- Department of Medical Oncology and Palliative Care, University Hospital of Giessen and Marburg, Giessen Site, Germany
| | - Daniel Berthold
- Department of Medical Oncology and Palliative Care, University Hospital of Giessen and Marburg, Giessen Site, Germany
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Poels M, Joppich R. [End-of-Life Care: medical and therapeutic aspects]. Anasthesiol Intensivmed Notfallmed Schmerzther 2023; 58:436-447. [PMID: 37582354 DOI: 10.1055/a-1977-7297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
According to data from the German Federal Statistical Office, 424635 patients died in hospitals across Germany in 2020. That is 43% of all deaths. Deaths occur everywhere in hospitals - not just in palliative care units - and caring for the dying is considered a basic task of medical practice 1. The German Medical Association has published principles for end-of-life care and the S3 guideline on palliative medicine also provides instructions on what end-of-life care should look like. However, there is often uncertainty as to what the care of the dying should look like in concrete terms. The following explanations are intended to convey how ideal end-of-life care should be designed and provide concrete assistance and suggestions as to how this can also succeed outside a palliative care unit.
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Wernli U, Hischier D, Meier CR, Jean-Petit-Matile S, Panchaud A, Kobleder A, Meyer-Massetti C. Prescription Trends in Hospice Care: A Longitudinal Retrospective and Descriptive Medication Analysis. Am J Hosp Palliat Care 2022:10499091221130758. [PMID: 36168963 DOI: 10.1177/10499091221130758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In hospice and palliative care, drug therapy is essential for symptom control. However, drug regimens are complex and prone to drug-related problems. Drug regimens must be simplified to improve quality of life and reduce risks associated with drug-related problems, particularly at end-of-life. To support clinical guidance towards a safe and effective drug therapy in hospice care, it is important to understand prescription trends. OBJECTIVES To explore prescription trends and describe changes to drug regimens in inpatient hospice care. DESIGN We performed a retrospective longitudinal and descriptive analysis of prescriptions for regular and as-needed (PRN) medication at three timepoints in deceased patients of one Swiss hospice. SETTING/SUBJECTS Prescription records of all patients (≥ 18 years) with an inpatient stay of three days and longer (admission and time of death in 2020) were considered eligible for inclusion. RESULTS Prescription records of 58 inpatients (average age 71.7 ± 12.8 [37-95] years) were analyzed. The medication analysis showed that polypharmacy prevalence decreased from 74.1% at admission to 13.8% on the day of death. For regular medication, overall numbers of prescriptions decreased over the patient stay while PRN medication decreased after the first consultation by the attending physician and increased slightly towards death. CONCLUSIONS Prescription records at admission revealed high initial rates of polypharmacy that were reduced steadily until time of death. These findings emphasize the importance of deprescribing at end-of-life and suggest pursuing further research on the contribution of clinical guidance towards optimizing drug therapy and deprescribing in inpatient hospice care.
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Affiliation(s)
- Ursina Wernli
- Clinical Pharmacology and Toxicology, 27252Inselspital University Hospital Bern, Bern, Switzerland.,Graduate School for Health Sciences, 27210University of Bern, Bern, Switzerland
| | - Désirée Hischier
- Clinical Pharmacy and Pharmacoepidemiology, 27209University of Basel, Basel, Switzerland
| | - Christoph R Meier
- Clinical Pharmacy and Pharmacoepidemiology, 27209University of Basel, Basel, Switzerland
| | | | - Alice Panchaud
- Institute of Primary Health Care (BIHAM), 27210University of Bern, Bern, Switzerland
| | - Andrea Kobleder
- Institute of Applied Nursing Science, 112888Eastern Switzerland University of Applied SciencesOST, St Gallen, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology and Toxicology, 27252Inselspital University Hospital Bern, Bern, Switzerland.,Clinical Pharmacy and Pharmacoepidemiology, 27209University of Basel, Basel, Switzerland
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