Sera Leah, Holmes Holly M, McPherson Mary Lynn
Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, 20 N. Pine Street, S405, Baltimore, MD, USA.
Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 1465, Houston, TX, USA.
Prog Palliat Care. 2014 Apr 1;22(2):69-74. doi: 10.1179/1743291X13Y.0000000068.
Despite being a common admitting diagnosis, there is very little published literature on medication management in hospice patients admitted with a diagnosis of failure to thrive or debility. The purpose of this study was to describe medication prescribing practices in hospice patients with either of these primary diagnoses by characterizing prescribed medications by name and by pharmaceutical class, and determining whether the patient or the hospice organization provided each medication.
A retrospective review of a patient information database compiled by a national hospice organization was conducted. Patients were included in this retrospective study if they were admitted to hospice care with a primary diagnosis of failure to thrive or debility, and if they were admitted on or after 1 January 2010, and discharged by death on or before 31 December 2010.
Overall 293 patients and 6181 medication entries were evaluated. The most commonly prescribed drugs were acetaminophen, lorazepam, morphine, atropine, prochlorperazine, haloperidol, docusate, aspirin, and bisacodyl. The most commonly prescribed pharmacological classes were opioid and non-opioid analgesics, anxiolytics, anticholinergics, antihypertensives, laxatives, antidepressants, and supplements. The hospice organization provided over 90% of prescriptions for analgesics, antipsychotics, anticholinergics, and anxiolytics, and these medications were discontinued before death in less than 5% of patients.
Recognized clinical components of failure to thrive syndrome include cognitive impairment, malnutrition, and depression. The hospice organization provided 80% of antidepressants, but infrequently provided appetite stimulants and drugs treating dementia. The most commonly provided drugs were those used for symptoms associated with most end-stage diseases.
尽管“发育不良或身体虚弱”是一种常见的入院诊断，但关于临终关怀患者药物管理的已发表文献却非常少。本研究的目的是通过按名称和药物类别对所开药物进行特征描述，并确定是患者还是临终关怀机构提供每种药物，来描述患有这两种主要诊断之一的临终关怀患者的药物处方实践。
对一个由全国性临终关怀机构汇编的患者信息数据库进行回顾性研究。如果患者因“发育不良或身体虚弱”的主要诊断而入住临终关怀护理，并且于2010年1月1日或之后入院，并于2010年12月31日或之前死亡，则纳入本回顾性研究。
总共评估了293名患者和6181条药物记录。最常开具的药物是对乙酰氨基酚、劳拉西泮、吗啡、阿托品、丙氯拉嗪、氟哌啶醇、多库酯、阿司匹林和比沙可啶。最常开具的药物类别是阿片类和非阿片类镇痛药、抗焦虑药、抗胆碱能药、抗高血压药、泻药、抗抑郁药和补充剂。临终关怀机构提供了超过90%的镇痛药、抗精神病药、抗胆碱能药和抗焦虑药处方，并且这些药物在不到5%的患者死亡前停用。
发育不良综合征公认的临床组成部分包括认知障碍、营养不良和抑郁。临终关怀机构提供了80%的抗抑郁药，但很少提供食欲刺激剂和治疗痴呆的药物。最常提供的药物是用于治疗大多数终末期疾病相关症状的药物。
