Use of Nonpalliative Medications Following Burdensome Health Care Transitions in Hospice Patients
| Autor: | Dima M. Qato, Gregory S. Calip, Todd A. Lee, Patrick M. Zueger, A. Simon Pickard, Holly M. Holmes |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Patient Transfer medicine.medical_specialty Psychological intervention MEDLINE Inappropriate Prescribing Medicare Cohort Studies 03 medical and health sciences 0302 clinical medicine Matched cohort Health care Epidemiology medicine Humans 030212 general & internal medicine Aged Aged 80 and over business.industry 030503 health policy & services Public Health Environmental and Occupational Health United States Confidence interval Discontinuation Hospitalization Hospice Care Emergency medicine Female 0305 other medical science business SEER Program Cohort study |
| Zdroj: | Medical Care. 57:13-20 |
| ISSN: | 0025-7079 |
| DOI: | 10.1097/mlr.0000000000001008 |
| Popis: | Background: Limited benefit medications (LBMs), those medications with questionable benefit at the end of life, are often recommended for discontinuation in hospice patients. Transitions in care are associated with inappropriate prescribing in older and terminally ill populations. Objectives: To evaluate the association between burdensome health care transitions and subsequent receipt of LBMs in older hospice patients. Methods: We conducted a matched cohort analysis of patients admitted to hospice between 2008 and 2013 using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. The prevalence of post–health care transition LBM use was assessed. Adjusted incidence rate ratios (IRRs) were estimated for the association between transitions and subsequent receipt of LBMs. Results: In total, 17.9% of 7064 hospice patients received at least 1 LBM following their first burdensome health care transition. Posttransition continuation of a medication class used before hospice admission was most common for antidementia medications (14.2%) and antihypertensives (11.2%). Transitions were associated with a 33% increase in the risk of receiving at least 1 LBM [IRR, 1.33; 95% confidence interval (CI), 1.25–1.42], increasing to 56% when evaluating only hospitalization transitions (IRR, 1.56; 95% CI, 1.39–1.76). Medication classes more likely to be dispensed after a transition included antihyperlipidemics (IRR, 1.38; 95% CI, 1.13–1.70), antihypertensives (IRR, 1.28; 95% CI, 1.16–1.40), and proton-pump inhibitors (IRR, 1.40; 95% CI, 1.20–1.63). Conclusions: Burdensome health care transitions were associated with the receipt of nonpalliative medications in older hospice patients. Interventions aimed at improving provider communication and reducing fragmentation in care may help reduce unnecessary medication use in this vulnerable population. |
| Databáze: | OpenAIRE |
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