Simon Jessica E, Bhattarai Asmita, Apoint-Hao Zhi-Yun, Roberts Rhiannon L, Milani Christina, Webber Colleen, Ewa Vivian, Clarke Anna E, Isenberg Sarina R, Kobewka Daniel, Qureshi Danial, Bush Shirley H, Boese Kaitlyn, Arya Amit, Robert Benoit, Downar James, Tanuseputro Peter, Sinnarajah Aynharan
Division of Palliative Care, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB.
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB.
Can Geriatr J. 2025 Mar 1;28(1):31-40. doi: 10.5770/cgj.28.811. eCollection 2025 Mar.
Prescribing rates for subcutaneous medications may be an indicator of quality of end-of-life care in long-term care (LTC). It is not known if this system level measure is valid across jurisdictions. We compared prescribing rates of medications used for end-of-life symptom relief among LTC residents in Alberta and Ontario.
This retrospective cohort study of LTC residents compared those who died between January 1, 2017, and March 17, 2020 in Alberta, with a published cohort from Ontario. Prescribed end-of-life medications during a resident's last 14 days of life were extracted from administrative dispensation records. LTC homes were ranked into quintiles based on prescribing rates within each home, and the home characteristics were described. The proportion of residents who transferred out of LTC in the last 14 days of life was also determined, as another quality measure.
We identified 10,038 decedents in 117 LTC homes. Among LTC decedents, 16.9% were prescribed ≥1 injectable end-of-life medication and 44.9% were prescribed at least one end-of-life medication by any route of administration, within the last 14 days of life. Across prescribing quintiles, there were no associations with transfer rates prior to death. Comparing Alberta to Ontario, there were markedly lower rates of injectable medicine prescribing (16.9% vs. 64.7%). Potential reasons and data limitations were explored.
Rates of injectable end-of life medication prescribing differed across Alberta LTC homes; however, current provincial data limitations impact the validity of using these rates as a comparative indicator of the quality of end-of-life care.
皮下用药的处方率可能是长期护理（LTC）中临终关怀质量的一个指标。尚不清楚这一系统层面的指标在不同司法管辖区是否有效。我们比较了艾伯塔省和安大略省长期护理机构居民中用于缓解临终症状的药物处方率。
这项针对长期护理机构居民的回顾性队列研究，将2017年1月1日至2020年3月17日期间在艾伯塔省死亡的居民与安大略省已发表的队列进行了比较。从行政配药记录中提取居民生命最后14天内开具的临终药物。根据每个机构内的处方率将长期护理机构分为五等份，并描述机构特征。还确定了在生命最后14天转出长期护理机构的居民比例，作为另一项质量指标。
我们在117个长期护理机构中识别出10038名死者。在长期护理机构的死者中，16.9%的人在生命的最后14天内被开具了≥1种注射用临终药物，44.9%的人通过任何给药途径被开具了至少一种临终药物。在各处方五等份中，与死亡前的转出率均无关联。将艾伯塔省与安大略省进行比较，注射药物的处方率明显较低（16.9%对64.7%）。探讨了潜在原因和数据局限性。
艾伯塔省各长期护理机构注射用临终药物的处方率存在差异；然而，目前省级数据的局限性影响了将这些率用作临终关怀质量比较指标的有效性。
