Prescription Trends in Hospice Care: A Longitudinal Retrospective and Descriptive Medication Analysis

Abstract

Background In hospice and palliative care, drug therapy is essential for symptom control. However, drug regimens are complex and prone to drug-related problems. Drug regimens must be simplified to improve quality of life and reduce risks associated with drug-related problems, particularly at end-of-life. To support clinical guidance towards a safe and effective drug therapy in hospice care, it is important to understand prescription trends. Objectives To explore prescription trends and describe changes to drug regimens in inpatient hospice care. Design We performed a retrospective longitudinal and descriptive analysis of prescriptions for regular and as-needed (PRN) medication at three timepoints in deceased patients of one Swiss hospice. Setting/subjects Prescription records of all patients ([Formula: see text] 18 years) with an inpatient stay of three days and longer (admission and time of death in 2020) were considered eligible for inclusion. Results Prescription records of 58 inpatients (average age 71.7 ± 12.8 [37-95] years) were analyzed. The medication analysis showed that polypharmacy prevalence decreased from 74.1% at admission to 13.8% on the day of death. For regular medication, overall numbers of prescriptions decreased over the patient stay while PRN medication decreased after the first consultation by the attending physician and increased slightly towards death. Conclusions Prescription records at admission revealed high initial rates of polypharmacy that were reduced steadily until time of death. These findings emphasize the importance of deprescribing at end-of-life and suggest pursuing further research on the contribution of clinical guidance towards optimizing drug therapy and deprescribing in inpatient hospice care.

Pharmacists’ clinical roles and activities in inpatient hospice and palliative care: a scoping review

“…However, end-of-life medication has to balance complex factors [ 2 ]. On average, palliative care patients receive 7.0–7.8 drugs daily [ 2 – 4 ]. Drug-related problems (DRPs), encompassing mainly inadequate drug treatment, inappropriate dosages, drug–drug interactions, adverse drug events, medication errors, and poor adherence [ 5 , 6 ], may arise from the patients’ general vulnerability, their comorbidities, and the high prevalence of polypharmacy [ 7 , 8 ].…”

“…In hospice and palliative care (HPC), drug therapy is focused on decreasing patients' symptom burden and improving their quality of life [1]. However, end-of-life medication has to balance complex factors [2]. On average, palliative care patients receive 7.0-7.8 drugs daily [2][3][4].…”