Rodrigues Inês, Ribeiro Hugo, Costa Carolina, Rocha-Neves João, Dourado Marília
Community Palliative Care Support Team Gaia, R. Bartolomeu Dias 316, 4430-043 Vila Nova de Gaia, Portugal.
Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
Pharmaceutics. 2024 Aug 30;16(9):1152. doi: 10.3390/pharmaceutics16091152.
Appropriate pharmacological management is a cornerstone of quality in palliative care (PC), focusing on comfort and quality of life. Therapeutic review is crucial in PC, aiming to optimize symptom relief, reduce adverse effects, and manage drug interactions. This study aims to delve into the real-world pharmacological prescription practices within a Community Palliative Care Support Team (CPCST) in the northern region of Portugal, comparing practices at admission and at the last consultation before death. It is an observational, cross-sectional, retrospective study without intervention involving patients admitted to a CPCST in 2021. Data were obtained from clinical records, and the statistical analysis included descriptive and inferential measures. Sixty-four patients were included, with an average age of 77.34 years, referred mainly by a specialized Hospital Palliative Care Support Team (65.63%). Polypharmacy was present, with a significant increase in opioids, antipsychotics, prokinetics, antiemetics, antispasmodics, and local corticosteroids, and a reduction in drugs for peptic ulcer and gastroesophageal reflux treatment, antithrombotics, hypolipidemics, antihypertensives, and antidiabetics, among others. The oral route was preferred, decreasing between the two analyzed moments (85.5% versus 49.1%). Pro re nata (PRN) medications increased significantly ( ≤ 0.001). The prescription profile reflects a focus on symptom relief. The deprescription of drugs for chronic comorbidities suggests adaptation to care goals. At the end of life, PRN medications increase significantly (1.34 versus 3.26, ≤ 0.001), administered as needed to soothe fluctuating symptoms. The pharmacological classes that have significantly increased are relevant in alleviating common symptoms in PC. The use of alternative routes for medication administration increases as instability of the oral route occurs, leading to a reduction in orally administered medications. Among these alternatives, the subcutaneous route shows the largest increase. The findings underscore the importance of flexible and responsive medication strategies in end-of-life care.
恰当的药物管理是姑息治疗（PC）质量的基石，重点在于舒适度和生活质量。治疗评估在姑息治疗中至关重要，旨在优化症状缓解、减少不良反应并管理药物相互作用。本研究旨在深入探究葡萄牙北部一个社区姑息治疗支持团队（CPCST）内的实际药物处方实践，比较入院时和死亡前最后一次会诊时的实践情况。这是一项观察性、横断面、回顾性研究，未对2021年入住CPCST的患者进行干预。数据从临床记录中获取，统计分析包括描述性和推断性测量。纳入了64名患者，平均年龄为77.34岁，主要由专业的医院姑息治疗支持团队转诊（65.63%）。存在多重用药情况，阿片类药物、抗精神病药物、促动力药、止吐药、解痉药和局部皮质类固醇显著增加，而用于消化性溃疡和胃食管反流治疗的药物、抗血栓药、降血脂药、抗高血压药和抗糖尿病药等减少。首选口服途径，在两个分析时间点之间有所下降（85.5%对49.1%）。按需（PRN）用药显著增加（≤0.001）。处方概况反映了对症状缓解的关注。针对慢性合并症的药物停用表明适应了护理目标。在生命末期，按需用药显著增加（1.34对3.26，≤0.001），根据需要给药以缓解波动的症状。显著增加的药物类别与缓解姑息治疗中的常见症状相关。随着口服途径不稳定，药物给药的替代途径使用增加，导致口服药物减少。在这些替代途径中皮下途径增加最多。研究结果强调了灵活且反应迅速的药物策略在临终关怀中的重要性。
