Palliative End-of-Life Medication Prescribing Rates in Long-Term Care: A Retrospective Cohort Study.
J Am Med Dir Assoc
; 25(3): 532-538.e8, 2024 Mar.
Article
in En
| MEDLINE
| ID: mdl-38242534
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 ANDPARTICIPANTS:
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.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Terminal Care
/
Long-Term Care
Type of study:
Etiology_studies
/
Observational_studies
Limits:
Humans
Country/Region as subject:
America do norte
Language:
En
Journal:
J Am Med Dir Assoc
Year:
2024
Document type:
Article