在 COVID-19 期间，长期护理居民的临终症状管理处方的变化。

Changes in End-of-Life Symptom Management Prescribing among Long-Term Care Residents during COVID-19.

机构信息

Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada.

Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

出版信息

J Am Med Dir Assoc. 2024 Jun;25(6):104955. doi: 10.1016/j.jamda.2024.01.024. Epub 2024 Mar 2.

DOI:10.1016/j.jamda.2024.01.024

PMID:38438112

Abstract

OBJECTIVE

To examine changes in the prescribing of end-of-life symptom management medications in long-term care (LTC) homes during the COVID-19 pandemic.

DESIGN

Retrospective cohort study using routinely collected health administrative data in Ontario, Canada.

SETTING AND PARTICIPANTS

We included all individuals who died in LTC homes between January 1, 2017, and March 31, 2021. We separated the study into 2 periods: before COVID-19 (January 1, 2017, to March 17, 2020) and during COVID-19 (March 18, 2020, to March 31, 2021).

METHODS

For each LTC home, we measured the percentage of residents who died before and during COVID-19 who had a subcutaneous symptom management medication prescription in their last 14 days of life. We grouped LTC homes into quintiles based on their mean prescribing rates before COVID-19, and examined changes in prescribing during COVID-19 and COVID-19 outcomes across quintiles.

RESULTS

We captured 75,438 LTC residents who died in Ontario's 626 LTC homes during the entire study period, with 19,522 (25.9%) dying during COVID-19. The mean prescribing rate during COVID-19 ranged from 46.9% to 79.4% between the lowest and highest prescribing quintiles. During COVID-19, the mean prescribing rate in the lowest prescribing quintile increased by 9.6% compared to before COVID-19. Compared to LTC homes in the highest prescribing quintile, homes in the lowest prescribing quintile experienced the highest proportion of COVID-19 outbreaks (73.4% vs 50.0%), the largest mean outbreak intensity (0.27 vs 0.09 cases/bed), the highest mean total days with a COVID-19 outbreak (72.7 vs 24.2 days), and the greatest proportion of decedents who were transferred and died outside of LTC (22.1% vs 8.6%).

CONCLUSIONS AND IMPLICATIONS

LTC homes in Ontario had wide variations in the prescribing rates of end-of-life symptom management medications before and during COVID-19. Homes in the lower prescribing quintiles had more COVID-19 cases per bed and days spent in an outbreak.

摘要

目的

在 COVID-19 大流行期间，调查长期护理（LTC）机构中临终症状管理药物的开处情况的变化。

设计

使用加拿大安大略省常规收集的健康管理数据进行回顾性队列研究。

设置和参与者

我们纳入了 2017 年 1 月 1 日至 2021 年 3 月 31 日期间在 LTC 机构中死亡的所有个体。我们将研究分为两个时期：COVID-19 之前（2017 年 1 月 1 日至 2020 年 3 月 17 日）和 COVID-19 期间（2020 年 3 月 18 日至 2021 年 3 月 31 日）。

方法

对于每个 LTC 机构，我们测量了 COVID-19 之前和期间在生命的最后 14 天内有皮下症状管理药物处方的死亡居民的百分比。我们根据 COVID-19 之前的平均处方率将 LTC 机构分为五组，并在 COVID-19 期间和 COVID-19 结果方面对五组进行了比较。

结果

我们共纳入了 75438 名在安大略省 626 个 LTC 机构中死亡的 LTC 居民，其中 19522 名（25.9%）在 COVID-19 期间死亡。COVID-19 期间，最低和最高处方组之间的平均处方率在 46.9%至 79.4%之间。在 COVID-19 期间，与 COVID-19 之前相比，最低处方组的平均处方率增加了 9.6%。与处方最高的五分之一的 LTC 机构相比，处方最低的五分之一的 LTC 机构经历了 COVID-19 爆发的比例最高（73.4%对 50.0%），平均爆发强度最大（0.27 对 0.09 例/床），平均爆发天数最长（72.7 对 24.2 天），并且死亡者转移和死于 LTC 机构之外的比例最高（22.1%对 8.6%）。