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Medication use in the last year of life: a cross-sectional hospice study
  1. Liam Scullion1,
  2. Hope Dodds1,
  3. Qinghao Liu1,
  4. Mary Elizabeth Hunt1,
  5. Simon Gordon2 and
  6. Adam Todd1
  1. 1School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
  2. 2St. Oswald's Hospice, Newcastle upon Tyne, UK
  1. Correspondence to Dr Adam Todd, School of Pharmacy, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; adam.todd{at}newcastle.ac.uk

Abstract

Objectives The issue of polypharmacy and medication use in people with life limiting illness raises important questions from a clinical and ethical viewpoint. The objectives of our study were to (1) explore medication use among people with life limiting illness receiving hospice care; (2) apply consensus criteria to assess medication appropriateness; and (3) determine the overall pill burden in this patient population.

Methods Six hospices in the North East of England were included. All deceased adult patients who received hospice care in 2018 were eligible for study inclusion. Descriptive statistics were used to report medication details; while medication appropriateness was assessed according to consensus criteria developed by Morin and colleagues.

Results Six hundred and ninety patients were included in the study. Patients were using a mean number of 8.8 medications per day, while polypharmacy was evident in 80% of patients. In terms of potentially questionable medication, patients were prescribed a mean number of 1.3 per day. Common potentially questionable medications included vitamin and mineral supplements, antihypertensives, antiplatelets, lipid regulating agents and anticoagulants. The pill burden in this population was also high with, on average, people using 13.7 oral doses per day.

Conclusions Polypharmacy is common in patients accessing hospice care, as is the use of potentially questionable medication. The pill burden in this patient population is also high, which may be an additional treatment burden to patients. Holistic deprescribing approaches for this population should be developed and implemented.

  • supportive care
  • survivorship
  • pharmacology
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Footnotes

  • Twitter @adamtodd138

  • LS, HD, QL and MEH contributed equally.

  • Contributors AT obtained funding, designed the study, supervised data collection and analysis and drafted the manuscript. SG supported the funding and helped develop the study design. LS, HD, QL and MEH led on data collection, analysis and provided critical comments on the manuscript. AT is the guarantor for the work.

  • Funding The authors gratefully acknowledge the Academic Health Science Network from the North East North Cumbria (AHSN NENC) who funded this work (ref IPH03).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Faculty of Medical Sciences Research Ethics Committee, part of Newcastle University’s Research Ethics Committee (approval number 1675/10895/2018).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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