Commonly Prescribed Medications in a Population of Hospice Patients

Sera, Leah; McPherson, Mary Lynn; Holmes, Holly M.

doi:10.1177/1049909113476132

Cited by 69 publications

(72 citation statements)

References 10 publications

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“…However, we also observed that only 68% of patients prescribed an opioid were also prescribed a laxative. The Centers for Medicare & Medicaid Services require that hospices publicly report the percentage of patients treated with an opioid who are offered or prescribed a bowel regimen . Although the Hospice Quality Reporting Program and other studies suggest that hospices are largely meeting this quality metric, our study suggests an opportunity for improvement on discharge to hospice care to reduce the risk of opioid‐induced constipation on hospice admission…”

Section: Discussionmentioning

confidence: 75%

“…Prescribing medications may be particularly challenging during the transition from acute care hospital settings to hospice care because of the often abrupt shift in goals of care and changes in underlying indications for medication use. This is significant because nearly 40% of hospice patients are referred to hospice care from an acute care hospital, and previous large studies suggested that hospice patients receive an average of 10 to 16 medications including several medications with unclear indications in the hospice setting (eg, statins, antithrombotic therapy, and antibiotics) …”

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confidence: 99%

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Frequency and Documentation of Medication Decisions on Discharge from the Hospital to Hospice Care

Kadoyama

Noble

Izumi

et al. 2019

J American Geriatrics Society

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OBJECTIVES To quantify the frequency and type of medication decisions on discharge from the hospital to hospice care. DESIGN Retrospective cohort study. SETTING A 544‐bed academic tertiary care hospital in Portland, Oregon. PARTICIPANTS A total of 348 adult patients (age ≥18 y) discharged to hospice care between January 1, 2010, and December 31, 2016. MEASUREMENTS Data were collected from an electronic repository of medical record data and a manual review of patients’ discharge summaries. Our outcomes of interest were the frequency and type of medication decisions documented in patients’ discharge summaries. Medication decisions were categorized as continuation, continuation but with changes in dose, route of administration, and/or frequency, discontinuation, and initiation of new medications. We also collected data on the frequency of patient/family in the participation of medication‐related decisions. RESULTS Patients were prescribed a mean of 7.1 medications (standard deviation [SD] = 4.8) on discharge to hospice care. The most prevalent medications prescribed on discharge were strong opioids (82.5%), anxiolytics/sedatives (62.9%), laxatives (57.5%), antiemetics (54.3%), and nonopioid analgesics (45.4%). However, only 67.8% (213/341) of patients who were prescribed an opioid on discharge to hospice care were also prescribed a laxative. Discharging providers made a mean of 15.0 decisions (SD = 7.2) per patient of which 28.5% were to continue medications without changes, 6.7% were to continue medications with changes, 30.3% were to initiate new medications, and 34.5% were to discontinue existing medications. Patients and/or family members were involved in medication decisions during 21.6% of discharges; patients were involved in 15.2% of decisions. CONCLUSION Patients averaged more than 15 medication decisions on discharge to hospice care. However, it was rarely documented that patients and/or their families participated in these decisions. J Am Geriatr Soc, 2019.

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Section: Discussionmentioning

confidence: 75%

mentioning

confidence: 99%

Frequency and Documentation of Medication Decisions on Discharge from the Hospital to Hospice Care

Kadoyama

Noble

Izumi

et al. 2019

J American Geriatrics Society

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“…Many patients who receive preventive cardiovascular drugs continue to do so until the very end of life . For example, the prescribing of antihypertensive agents and platelet aggregation inhibitors is commonplace among hospice patients with advanced cancer . Recent studies also have shown that polypharmacy increases near the end of life, which is fueled not only by symptomatic drugs but also by the continuation of preventive agents until the very last weeks of life …”

Section: Discussionmentioning

confidence: 99%

“…26,27 For example, the prescribing of antihypertensive agents and platelet aggregation inhibitors is commonplace among hospice patients with advanced cancer. 28 Recent studies also have shown that polypharmacy increases near the end of life, which is fueled not only by symptomatic drugs but also by the continuation of preventive agents until the very last weeks of life. 18,24 The frequent continuation of long-term preventive drugs is indicative of insufficient deprescribing strategies at the end of life.…”

Section: Discussionmentioning

confidence: 99%

Preventive drugs in the last year of life of older adults with cancer: Is there room for deprescribing?

Morin

Todd

Barclay

et al. 2019

Cancer

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Background The continuation of preventive drugs among older patients with advanced cancer has come under scrutiny because these drugs are unlikely to achieve their clinical benefit during the patients’ remaining lifespan. Methods A nationwide cohort study of older adults (those aged ≥65 years) with solid tumors who died between 2007 and 2013 was performed in Sweden, using routinely collected data with record linkage. The authors calculated the monthly use and cost of preventive drugs throughout the last year before the patients’ death. Results Among 151,201 older persons who died with cancer (mean age, 81.3 years [standard deviation, 8.1 years]), the average number of drugs increased from 6.9 to 10.1 over the course of the last year before death. Preventive drugs frequently were continued until the final month of life, including antihypertensives, platelet aggregation inhibitors, anticoagulants, statins, and oral antidiabetics. Median drug costs amounted to $1482 (interquartile range [IQR], $700‐$2896]) per person, including $213 (IQR, $77‐$490) for preventive therapies. Compared with older adults who died with lung cancer (median drug cost, $205; IQR, $61‐$523), costs for preventive drugs were higher among older adults who died with pancreatic cancer (adjusted median difference, $13; 95% confidence interval, $5‐$22) or gynecological cancers (adjusted median difference, $27; 95% confidence interval, $18‐$36). There was no decrease noted with regard to the cost of preventive drugs throughout the last year of life. Conclusions Preventive drugs commonly are prescribed during the last year of life among older adults with cancer, and often are continued until the final weeks before death. Adequate deprescribing strategies are warranted to reduce the burden of drugs with limited clinical benefit near the end of life.

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“…Our findings are similar to the polypharmacy burden near the end of life reported by others, however with several key differences. Three studies have previously assessed medication prescribed during end-of-life care (3,18,19). The first, Nauck et al, a representative survey of drugs in palliative care performed in Germany, demonstrated strong opioids as the most common class.…”

Section: Discussionmentioning

confidence: 99%

The Burden of Polypharmacy in Patients Near the End of Life

McNeil

Kamal

Kutner

et al. 2016

Journal of Pain and Symptom Management

108

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Context Patients with advanced illness are prescribed multiple medications in the last year of life, intensifying the risk of negative consequences related to polypharmacy. Objectives To describe the medication burden of patients near the end of life and identify potential areas for improvement in clinician prescribing practices. Methods This was a pre-specified secondary analysis of data from a prospective trial. Eligible participants were adults with less than 12 months estimated prognosis taking a statin medication for primary prevention of cardiovascular disease. Participants were enrolled from 15 sites, randomized to continue or discontinue statin medications, and followed for up to a year. Concomitant medications were recorded at least monthly from study enrollment through death. Prescribed medications were categorized by class and subclass. Descriptive statistics were calculated. Results On average, participants (N=244) were 74.3 years old (SD 11.5) and lived 264 days (SD 128); 47.5% of the patients had a primary diagnosis of malignant tumor. This population was exposed to medications across 51 classes, 192 subclasses and 423 individual medications. Patients took an average of 11.5 (SD 5) medications at the time of enrollment and 10.7 (SD 5) medications at death or study termination. The five most common classes of medications prescribed near the end of life were, anti-hypertensives, broncholytics/bronchodilators, laxatives, antidepressants, and gastric protection agents. Conclusion There is a significant medication burden placed on patients with advanced illness. Although most medications were prescribed for supportive care, we observed a high prevalence of medications for managing non-life threatening comorbidities.

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Commonly Prescribed Medications in a Population of Hospice Patients

Cited by 69 publications

References 10 publications

Frequency and Documentation of Medication Decisions on Discharge from the Hospital to Hospice Care

Frequency and Documentation of Medication Decisions on Discharge from the Hospital to Hospice Care

Preventive drugs in the last year of life of older adults with cancer: Is there room for deprescribing?

The Burden of Polypharmacy in Patients Near the End of Life

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