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

PURPOSE

To determine the use of avoidable medications in end-of-life patients living at home when they were moved from the general practice setting to the palliative medicine physician (T) and before death (T).

METHODS

This retrospective longitudinal study describes the prevalence of end-of-life patients cared for at home between April 2016 and December 2018 receiving preventive and symptomatic drug treatments. Socio-demographic data, diagnosis and drug treatments for each patient were collected in a web-based Case Report Form.

RESULTS

The study sample comprised 1565 end-of-life patients with a median age (25-75 percentile) of 79.8 (72.5-85.3 years). All patients were treated with symptomatic drugs, and there were significantly fewer patients from T to T with at least one preventive medication at end of life (92.1% and, 60.8%, p < 0.0001). There was a significant variability between the palliative care physicians in the mean numbers of avoidable preventive medication (1.5-3.9 at T and 0.4-2.7 at T, p = 0.06) prescribed.

CONCLUSION

More than half end-of-life patients living at home still receive avoidable medications. Drug prescription needs to be improved and palliative care setting could have an important role in reducing potentially inappropriate prescriptions. Emphasizing the positive aspects of stopping medicines, shared criteria with de-prescribing guidelines for potentially inappropriate medication in end-of-life patients and multidisciplinary discussion with involvement of patient and family caregivers could be useful to rationalize drug therapy.