Clinical Pharmacology and Toxicology, Inselspital University Hospital Bern, Bern, Switzerland.
Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
Am J Hosp Palliat Care. 2023 Aug;40(8):820-828. doi: 10.1177/10499091221130758. Epub 2022 Sep 28.
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.
To explore prescription trends and describe changes to drug regimens in inpatient hospice care.
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 ( 18 years) with an inpatient stay of three days and longer (admission and time of death in 2020) were considered eligible for inclusion.
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.
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.
在临终关怀和姑息治疗中，药物治疗对于控制症状至关重要。然而，药物治疗方案复杂，容易出现与药物相关的问题。为了提高生活质量并降低与药物相关问题相关的风险，特别是在生命末期，必须简化药物治疗方案。为了支持针对临终关怀中安全有效的药物治疗的临床指导，了解处方趋势非常重要。
探讨住院临终关怀中处方趋势并描述药物治疗方案的变化。
我们对一家瑞士临终关怀机构的三位已故患者的常规和按需（PRN）药物处方进行了回顾性纵向和描述性分析。
设置/受试者：在 2020 年，所有入住时间为三天或更长时间的（入院和死亡时间）年龄在 18 岁及以上的患者的处方记录都被认为符合纳入标准。
分析了 58 名住院患者（平均年龄 71.7 ± 12.8 [37-95] 岁）的处方记录。药物分析显示，入院时的多药治疗患病率从 74.1%降至死亡当天的 13.8%。对于常规药物治疗，总体处方数量在患者住院期间减少，而 PRN 药物治疗在主治医生首次就诊后减少，在接近死亡时略有增加。
入院时的处方记录显示初始的高聚药率，这些聚药率稳步降低直至死亡。这些发现强调了在生命末期减少药物的重要性，并建议进一步研究临床指导对优化住院临终关怀中的药物治疗和减少药物的贡献。
