Changes in End-of-Life Symptom Management Prescribing among Long-Term Care Residents during COVID-19.
J Am Med Dir Assoc
; 25(6): 104955, 2024 Jun.
Article
in En
| MEDLINE
| ID: mdl-38438112
ABSTRACT
OBJECTIVE:
To examine changes in the prescribing of end-of-life symptom management medications in long-term care (LTC) homes during the COVID-19 pandemic.DESIGN:
Retrospective cohort study using routinely collected health administrative data in Ontario, Canada. SETTING ANDPARTICIPANTS:
We included all individuals who died in LTC homes between January 1, 2017, and March 31, 2021. We separated the study into 2 periods before COVID-19 (January 1, 2017, to March 17, 2020) and during COVID-19 (March 18, 2020, to March 31, 2021).METHODS:
For each LTC home, we measured the percentage of residents who died before and during COVID-19 who had a subcutaneous symptom management medication prescription in their last 14 days of life. We grouped LTC homes into quintiles based on their mean prescribing rates before COVID-19, and examined changes in prescribing during COVID-19 and COVID-19 outcomes across quintiles.RESULTS:
We captured 75,438 LTC residents who died in Ontario's 626 LTC homes during the entire study period, with 19,522 (25.9%) dying during COVID-19. The mean prescribing rate during COVID-19 ranged from 46.9% to 79.4% between the lowest and highest prescribing quintiles. During COVID-19, the mean prescribing rate in the lowest prescribing quintile increased by 9.6% compared to before COVID-19. Compared to LTC homes in the highest prescribing quintile, homes in the lowest prescribing quintile experienced the highest proportion of COVID-19 outbreaks (73.4% vs 50.0%), the largest mean outbreak intensity (0.27 vs 0.09 cases/bed), the highest mean total days with a COVID-19 outbreak (72.7 vs 24.2 days), and the greatest proportion of decedents who were transferred and died outside of LTC (22.1% vs 8.6%). CONCLUSIONS AND IMPLICATIONS LTC homes in Ontario had wide variations in the prescribing rates of end-of-life symptom management medications before and during COVID-19. Homes in the lower prescribing quintiles had more COVID-19 cases per bed and days spent in an outbreak.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Terminal Care
/
Long-Term Care
/
SARS-CoV-2
/
COVID-19
/
Nursing Homes
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
Country/Region as subject:
America do norte
Language:
En
Journal:
J Am Med Dir Assoc
Journal subject:
HISTORIA DA MEDICINA
/
MEDICINA
Year:
2024
Document type:
Article
Affiliation country:
Country of publication: