Prevalence and Clinical Intentions of Antithrombotic Therapy on Discharge to Hospice Care

Kowalewska, Christina A; Noble, Brie N.; Fromme, Erik K.; McPherson, Mary Lynn; Grace, Kristi N.; Furuno, Jon P.

doi:10.1089/jpm.2016.0487

Cited by 21 publications

(16 citation statements)

References 19 publications

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“…The use of TPX in hospice patients in another UK study was even lower, at 3.7% [16]. A retrospective cohort study by Kowalewska et al [17] revealed that 6.7% of all (77 out of 1141) patients and 4.6% of cancer patients discharged from hospital to hospice care were prescribed antithrombotic therapy. It was shown that cancer patients, which constituted 60% of the study group, were significantly less likely to receive a prescription for anticoagulation, and the rationale for the de-escalation of TPX was increased bleeding risk, inconsistency with goals of care, or patient or family preference.…”

Section: Prevalence Of Thromboprophylaxis In Hospices and Palliative mentioning

confidence: 90%

Thromboprophylaxis in the End-of-Life Cancer Care: The Update

Zabrocka

Sierko

2020

Cancers

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Cancer patients are at increased risk for venous thromboembolism (VTE), which further increases with advanced stages of malignancy, prolonged immobilization, or prior history of thrombosis. To reduce VTE-related mortality, many official guidelines encourage the use of thromboprophylaxis (TPX) in cancer patients in certain situations, e.g., during chemotherapy or in the perioperative period. TPX in the end-of-life care, however, remains controversial. Most recommendations on VTE prophylaxis in cancer patients are based on the outcomes of clinical trials that excluded patients under palliative or hospice care. This translates to the paucity of official guidelines on TPX dedicated to this group of patients. The problem should not be underestimated as VTE is known to be associated with symptoms adversely impacting the quality of life (QoL), i.e., limb or chest pain, dyspnea, hemoptysis. In end-of-life care, where the assurance of the best possible QoL should be the highest priority, VTE prophylaxis may eliminate the symptom burden related to thrombosis. However, large randomized studies determining the benefits and risks profiles of TPX in patients nearing the end of life are lacking. This review summarized available data on TPX in this population, analyzed potential tools for VTE risk prediction in the view of this group of patients, and summarized the most current recommendations on TPX pertaining to terminal care.

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Section: Prevalence Of Thromboprophylaxis In Hospices and Palliative mentioning

confidence: 90%

Thromboprophylaxis in the End-of-Life Cancer Care: The Update

Zabrocka

Sierko

2020

Cancers

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“…Methods of cohort identification were previously described . Briefly, eligible patients were identified as having been discharged to hospice care using discharge disposition data from the OHSU Department of Care Management.…”

Section: Methodsmentioning

confidence: 99%

“…Methods of cohort identification were previously described. 8,9 Briefly, eligible patients were identified as having been discharged to hospice care using discharge disposition data from the OHSU Department of Care Management. We randomly sampled 20% of eligible patients from each year of the study period and reviewed these patients' discharge summaries that were available in the electronic health record.…”

Section: Data Collectionmentioning

confidence: 99%

“…Previous studies suggested that hospice medications are frequently continuations of medications initiated in the hospital as active, curative therapy, despite the shift from curative to palliative goals of care . Furthermore, we previously reported that acute care providers frequently prescribe medications with unclear indications and unknown safety and effectiveness (eg, antibiotics, antithrombotic therapy) to patients on discharge to hospice care . Further, medication decisions for these patients transitioning to hospice care are often made with limited input from palliative care specialists …”

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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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“…These data have been previously used in epidemiologic studies of medication prescribing upon discharge. [20][21][22] Our primary outcome of interest was receiving an outpatient prescription for an antibiotic upon discharge from acute care to an LTCF. In addition, we identified the potential infectious indication for each antibiotic prescription.…”

Section: Data Collection and Variable Definitionsmentioning

confidence: 99%

Antibiotic prescribing upon discharge from the hospital to long-term care facilities: Implications for antimicrobial stewardship requirements in post-acute settings

Weber

Noble

Bearden

et al. 2018

Infect. Control Hosp. Epidemiol.

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ObjectiveTo quantify the frequency and outcomes of receiving an antibiotic prescription upon discharge from the hospital to long-term care facilities (LTCFs).DesignRetrospective cohort study.SettingA 576-bed, academic hospital in Portland, Oregon.PatientsAdult inpatients (≥18 years of age) discharged to an LTCF between January 1, 2012, and June 30, 2016.MethodsOur primary outcome was receiving a systemic antibiotic prescription upon discharge to an LTCF. We also quantified the association between receiving an antibiotic prescription and 30-day hospital readmission, 30-day emergency department (ED) visit, and Clostridium difficile infection (CDI) on a readmission or ED visit at the index facility within 60 days of discharge.ResultsAmong 6,701 discharges to an LTCF, 22.9% were prescribed antibiotics upon discharge. The most prevalent antibiotic classes prescribed were cephalosporins (20.4%), fluoroquinolones (19.1%), and penicillins (16.7%). The medical records of ~82% of patients included a diagnosis code for a bacterial infection on the index admission. Among patients prescribed an antibiotic upon discharge, the incidence of 30-day hospital readmission to the index facility was 15.9%, the incidence of 30-day ED visit at the index facility was 11.0%, and the incidence of CDI on a readmission or ED visit within 60 days of discharge was 1.6%. Receiving an antibiotic prescription upon discharge was significantly associated with 30-day ED visits (adjusted odds ratio [aOR], 1.2; 95% confidence interval [CI], 1.02–1.5) and with CDI within 60 days (aOR, 1.7; 95% CI, 1.02–2.8) but not with 30-day readmissions (aOR, 1.01; 95% CI, 0.9–1.2).ConclusionsAntibiotics were frequently prescribed upon discharge to LTCFs, which may be associated with increased risk of poor outcomes post discharge.

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Prevalence and Clinical Intentions of Antithrombotic Therapy on Discharge to Hospice Care

Abstract: Prescriptions for antithrombotic therapy were infrequent and often lacked a documented rationale. Further research is needed on the safety and effectiveness of antithrombotic therapy in hospice care and what drives current medication decisions in the absence of these data.

Cited by 21 publications

References 19 publications

Thromboprophylaxis in the End-of-Life Cancer Care: The Update

Thromboprophylaxis in the End-of-Life Cancer Care: The Update

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

Antibiotic prescribing upon discharge from the hospital to long-term care facilities: Implications for antimicrobial stewardship requirements in post-acute settings

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