Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL.
Division of Geriatric and Palliative Medicine, UTHealth McGovern Medical School, Houston, TX.
Med Care. 2019 Jan;57(1):13-20. doi: 10.1097/MLR.0000000000001008.
Limited benefit medications (LBMs), those medications with questionable benefit at the end of life, are often recommended for discontinuation in hospice patients. Transitions in care are associated with inappropriate prescribing in older and terminally ill populations.
To evaluate the association between burdensome health care transitions and subsequent receipt of LBMs in older hospice patients.
We conducted a matched cohort analysis of patients admitted to hospice between 2008 and 2013 using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. The prevalence of post-health care transition LBM use was assessed. Adjusted incidence rate ratios (IRRs) were estimated for the association between transitions and subsequent receipt of LBMs.
In total, 17.9% of 7064 hospice patients received at least 1 LBM following their first burdensome health care transition. Posttransition continuation of a medication class used before hospice admission was most common for antidementia medications (14.2%) and antihypertensives (11.2%). Transitions were associated with a 33% increase in the risk of receiving at least 1 LBM [IRR, 1.33; 95% confidence interval (CI), 1.25-1.42], increasing to 56% when evaluating only hospitalization transitions (IRR, 1.56; 95% CI, 1.39-1.76). Medication classes more likely to be dispensed after a transition included antihyperlipidemics (IRR, 1.38; 95% CI, 1.13-1.70), antihypertensives (IRR, 1.28; 95% CI, 1.16-1.40), and proton-pump inhibitors (IRR, 1.40; 95% CI, 1.20-1.63).
Burdensome health care transitions were associated with the receipt of nonpalliative medications in older hospice patients. Interventions aimed at improving provider communication and reducing fragmentation in care may help reduce unnecessary medication use in this vulnerable population.
有限效益药物（LBMs）是指在生命末期疗效可疑的药物，通常建议在临终关怀患者中停止使用。医疗保健过渡与老年和终末期患者中不适当的处方有关。
评估在老年临终关怀患者中，繁琐的医疗保健过渡与随后接受 LBM 之间的关联。
我们使用监测、流行病学和最终结果（SEER）-医疗保险链接数据库，对 2008 年至 2013 年期间入院的临终关怀患者进行了匹配队列分析。评估了首次繁琐的医疗保健过渡后 LBM 使用的流行情况。估计了过渡与随后接受 LBM 之间的关联的调整发病率比率（IRR）。
在总共 7064 名接受临终关怀的患者中，有 17.9%的患者在首次经历繁琐的医疗保健过渡后至少接受了 1 种 LBM。过渡后继续使用入院前使用的药物类别最常见的是抗痴呆药物（14.2%）和降压药（11.2%）。过渡与接受至少 1 种 LBM 的风险增加 33%相关[IRR，1.33；95%置信区间（CI），1.25-1.42]，当仅评估住院过渡时，这一比例增加到 56%[IRR，1.56；95%CI，1.39-1.76]。过渡后更有可能配药的药物类别包括抗血脂药物（IRR，1.38；95%CI，1.13-1.70）、降压药（IRR，1.28；95%CI，1.16-1.40）和质子泵抑制剂（IRR，1.40；95%CI，1.20-1.63）。
繁琐的医疗保健过渡与老年临终关怀患者接受非姑息性药物治疗有关。旨在改善提供者沟通和减少护理碎片化的干预措施可能有助于减少这一脆弱人群中不必要的药物使用。
