Medication at end of life indicates care quality

By Sarah Guy, medwireNews Reporter

Medication given to patients at the end of life varies according to whether they are being cared for in a hospice or hospital, and has the potential to indicate the quality of their care, suggest researchers.

In a chart review of almost 200 patients' medication usage in the last 3 days of life, 10 out of 16 medications were classified as potentially inappropriate. These included antihypertensives, antiarrthymics, antibiotics, antiulcer drugs, and steroids, with the latter two the most commonly used.

There is a "growing interest in potential indicators for inappropriate care" in end-of-life care, explain Natasja Raijmakers (Erasmus MC University Medical Center, Rotterdam, the Netherlands) and co-workers, adding that such care can be "aggressive" and includes chemotherapy close to death and futile medication among people with a limited life expectancy.

"Attention to end-of-life care in hospitals has increased, as reflected in the growth of palliative care services in hospitals, such as palliative care consultation teams and the increasing use of care pathways for dying patients," say Raijmakers et al in Supportive Care in Cancer.

Their conclusions emerge from a survey-based study that included responses from 16 palliative care physicians from nine countries on 135 palliative patients treated between December 2006 and July 2009, and 60 consecutive cancer patients who died between February and May 2011.

Patients were residing either in a hospice (n=60) or a hospital (n=135) and were aged a mean 72 and 74 years, respectively. Overall, patients were taking an average 4.8 medications in the last 3 days of life, with averages of 5.1 for those in hospital and 4.7 for those in hospice care.

Following the identification of 16 medications in patient charts, 94% of the international healthcare professions agreed that 12 were potentially inappropriate. Hospital patients were significantly more likely than hospice patients to receive inappropriate antiulcer drugs, antibiotics, vasodilators, and dopamine, with odds ratio of 3.5, 3.1, 4.9, and 8.4, respectively.

Patients who were treated in hospitals before the implementation of the Liverpool Care Pathway (LCP) had a significantly higher probability of receiving vasodilator drugs than those who were treated afterwards, report the researchers.

"Using end-of-life pathways may support professionals in recognizing the dying phase, increase awareness among professionals, and create an opportunity to discuss the situation with the patient and family," says the research team.

Opioids and morphine were the most commonly used appropriate medications in both patient settings.

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