Inappropriate medications among end-of-life patients living at home: an Italian observational study

Pasina, Luca; Recchia, Angela; Nobili, Alessandro; Rizzi, B

doi:10.1007/s41999-020-00315-0

Cited by 14 publications

(14 citation statements)

References 19 publications

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“…The prescriptive behavior of preventive drugs did not differ considerably in patients with cancer and those with other chronic non neoplastic diseases, although in the latter group of patients there was a more marked tendency towards a reduction in prescription over the The results of our study are consistent with those of previous investigations on end-of-life-patients -conducted largely on (cancer) patients treated in hospice or palliative carewhich reported a frequent use of avoidable medications up to the last months of life. 5,[8][9][10][11][12][13]25,26 In particular, our results on oncologic patients are very consistent with those of a similar study conducted in the Swedish population. 12 All these data suggest that drug prescription at the endof-life needs to be improved.…”

Section: Discussionsupporting

confidence: 91%

Use of preventive drugs during the last year of life in older adults with cancer or chronic progressive diseases

Bosetti

Santucci

Pasina

et al. 2021

Pharmacoepidemiology and Drug

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Purpose: To evaluate the prescription of preventive medications with questionable usefulness in community dwelling elderly adults with cancer or chronic progressive diseases during the last year of life.Methods: Through the utilization of the healthcare databases of the Lombardy region, Italy, we identified two retrospective cohorts of patients aged 65 years or more, who died in 2018 and had a diagnosis of either a solid cancer (N = 19 367) or a chronic progressive disease (N = 27 819). We estimated prescription of eight major classes of preventive drugs 1 year and 1 month before death; continuation or initiation of preventive drug use during the last month of life was also investigated.Results: Over the last year of life, in both oncologic and non-oncologic patients, we observed a modest decrease in the prescription of blood glucose-lowering drugs, anti-hypertensives, lipid-modifying agents, and bisphosphonates, and a slight increase in the prescription of vitamins, minerals, antianemic drugs, and antithrombotic agents (among oncologic patients only). One month before death, the prescription of preventive drugs was still common, particularly for anti-hypertensives, antithrombotics, and antianemics, with more than 60% of patients continuing to be prescribed most preventive drugs and an over 10% starting a therapy with an antithrombotic, an antianemic, or a vitamin or mineral supplement. Conclusion:These findings support the need for an appropriate drug review and improvement in the quality of drug prescription for vulnerable populations at the end-of-life.

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Section: Discussionsupporting

confidence: 91%

Use of preventive drugs during the last year of life in older adults with cancer or chronic progressive diseases

Bosetti

Santucci

Pasina

et al. 2021

Pharmacoepidemiology and Drug

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“…In our study, we found a relatively high prevalence of antithrombotic use (60 %) compared to previous studies [1][2][3]5]. We do not have a plausible explanation for this.…”

Section: Discussioncontrasting

confidence: 77%

“…Antithrombotics are frequently prescribed to patients with a life-limiting disease [1][2][3][4][5][6][7]. They mainly involve platelet aggregation inhibitors (PAIs) or anticoagulants.…”

Section: Introductionmentioning

confidence: 99%

“…The main indications for antithrombotic use in this study were AF (41.6 %), history of stroke (31.2 %), deep venous thrombosis (DVT) or pulmonary embolism (PE) (11.7 %) or heart valve replacement (10.4 %). Various other studies have shown that up to half of all patients with an advanced illness and frail elderly patients continue to use antithrombotics in the last weeks of life [1][2][3][4]. A large cohort study in Sweden in older adults showed that antithrombotic use was similar (about 50 %) 12 months and one month before death.…”

Section: Introductionmentioning

confidence: 99%

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Use of antithrombotics at the end of life: an in-depth chart review study

et al. 2021

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Background Antithrombotics are frequently prescribed for patients with a limited life expectancy. In the last phase of life, when treatment is primarily focused on optimizing patients’ quality of life, the use of antithrombotics should be reconsidered. Methods We performed a secondary analysis of a retrospective review of 180 medical records of patients who had died of a malignant or non-malignant disease, at home, in a hospice or in a hospital, in the Netherlands. All medication prescriptions and clinical notes of patients using antithrombotics in the last three months of life were reviewed manually. We subsequently developed case vignettes based on a purposive sample, with variation in setting, age, gender, type of medication, and underlying disease. Results In total 60% (n=108) of patients had used antithrombotics in the last three months of life. Of all patients using antithrombotics 33.3 % died at home, 21.3 % in a hospice and 45.4 % in a hospital. In total, 157 antithrombotic prescriptions were registered; 30 prescriptions of vitamin K antagonists, 60 of heparins, and 66 of platelet aggregation inhibitors. Of 51 patients using heparins, 32 only received a prophylactic dose. In 75.9 % of patients antithrombotics were continued until the last week before death. Case vignettes suggest that inability to swallow, bleeding complications or the dying phase were important factors in making decisions about the use of antithrombotics. Conclusions Antithrombotics in patients with a life limiting disease are often continued until shortly before death. Clinical guidance may support physicians to reconsider (dis)continuation of antithrombotics and discuss this with the patient.

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“…1 ). 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 Three studies had more than one reference. 63 , 64 , 66 , 67 , 79 , 80 All other articles did not meet the inclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

Prescribing practices, patterns, and potential harms in patients receiving palliative care: A systematic scoping review

Cadogan

Murphy

Boland

et al. 2021

Exploratory Research in Clinical and Social Pharmacy

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Inappropriate medications among end-of-life patients living at home: an Italian observational study

Cited by 14 publications

References 19 publications

Use of preventive drugs during the last year of life in older adults with cancer or chronic progressive diseases

Use of preventive drugs during the last year of life in older adults with cancer or chronic progressive diseases

Use of antithrombotics at the end of life: an in-depth chart review study

Prescribing practices, patterns, and potential harms in patients receiving palliative care: A systematic scoping review

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