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长期护理中临终姑息治疗药物处方率:一项回顾性队列研究。

Palliative End-of-Life Medication Prescribing Rates in Long-Term Care: A Retrospective Cohort Study.

作者信息

Tanuseputro Peter, Roberts Rhiannon L, Milani Christina, Clarke Anna E, Webber Colleen, Isenberg Sarina R, Kobewka Daniel, Turcotte Luke, Bush Shirley H, Boese Kaitlyn, Arya Amit, Robert Benoit, Sinnarajah Aynharan, Simon Jessica E, Howard Michelle, Lau Jenny, Qureshi Danial, Fremont Deena, Downar James

机构信息

Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada.

Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

出版信息

J Am Med Dir Assoc. 2024 Mar;25(3):532-538.e8. doi: 10.1016/j.jamda.2023.11.026. Epub 2024 Jan 17.

Abstract

BACKGROUND

Medications are often needed to manage distressing end-of-life symptoms (eg, pain, agitation).

OBJECTIVES

In this study, we describe the variation in prescribing rates of symptom relief medications at the end of life among long-term care (LTC) decedents. We evaluate the extent these medications are prescribed in LTC homes and whether prescribing rates of end-of-life symptom management can be used as an indicator of quality end-of-life care.

DESIGN

Retrospective cohort study using administrative health data.

SETTING AND PARTICIPANTS

LTC decedents in all 626 publicly funded LTC homes in Ontario, Canada, between January 1, 2017, and March 17, 2020.

METHODS

For each LTC home, we measured the percent of decedents who received 1+ prescription(s) for a subcutaneous end-of-life symptom management medication ("end-of-life medication") in their last 14 days of life. We then ranked LTC homes into quintiles based on prescribing rates.

RESULTS

We identified 55,916 LTC residents who died in LTC. On average, two-thirds of decedents (64.7%) in LTC homes were prescribed at least 1 subcutaneous end-of-life medication in the last 2 weeks of life. Opioids were the most common prescribed medication (overall average prescribing rate of 62.7%). LTC homes in the lowest prescribing quintile had a mean of 37.3% of decedents prescribed an end-of-life medication, and the highest quintile mean was 82.5%. In addition, across these quintiles, the lowest prescribing quintile had a high average (30.3%) of LTC residents transferred out of LTC in the 14 days compared with the highest prescribing quintile (12.7%).

CONCLUSIONS AND IMPLICATIONS

Across Ontario's LTC homes, there are large differences in prescribing rates for subcutaneous end-of-life symptom relief medications. Although future work may elucidate why the variability exists, this study provides evidence that administrative data can provide valuable insight into the systemic delivery of end-of-life care.

摘要

背景

通常需要药物来控制临终时令人痛苦的症状(如疼痛、烦躁)。

目的

在本研究中,我们描述了长期护理(LTC)机构中临终者缓解症状药物的处方率差异。我们评估了这些药物在LTC机构中的处方情况,以及临终症状管理的处方率是否可作为优质临终护理的指标。

设计

使用行政健康数据的回顾性队列研究。

设置和参与者

2017年1月1日至2020年3月17日期间,加拿大安大略省所有626家公共资助的LTC机构中的LTC临终者。

方法

对于每个LTC机构,我们测量了在其生命的最后14天内接受过1种或更多皮下临终症状管理药物(“临终药物”)处方的临终者的百分比。然后,我们根据处方率将LTC机构分为五等份。

结果

我们确定了55916名在LTC机构死亡的居民。平均而言,LTC机构中三分之二(64.7%)的临终者在生命的最后2周内至少接受了1种皮下临终药物的处方。阿片类药物是最常用的处方药物(总体平均处方率为62.7%)。处方率最低的五分之一LTC机构中,平均有37.3%的临终者接受了临终药物的处方,而最高的五分之一机构的平均处方率为82.5%。此外,在这些五等份中,处方率最低的五分之一机构中,有30.3%的LTC居民在14天内转出LTC机构,而处方率最高的五分之一机构这一比例为12.7%。

结论与启示

在安大略省的LTC机构中,皮下临终症状缓解药物的处方率存在很大差异。尽管未来的研究可能会阐明这种差异存在的原因,但本研究提供了证据,表明行政数据可以为临终护理的系统提供有价值的见解。

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