TY - JOUR
T1 - Frequency and Documentation of Medication Decisions on Discharge from the Hospital to Hospice Care
AU - Kadoyama, Kirsten L.
AU - Noble, Brie N.
AU - Izumi, Shigeko
AU - Fromme, Erik
AU - Tjia, Jennifer
AU - McPherson, Mary Lynn
AU - Candrian, Carey B.
AU - McGregor, Jessina C.
AU - Ku, In Young
AU - Furuno, Jon P.
N1 - Funding Information:
The authors would like to thank Kristi Grace and Michael Gourley-Genung for assistance with acquisition of discharge disposition data. Conflict of Interest: Jon P. Furuno has received consultant fees from Merck & Co. and Shionogi & Co., Ltd. and research funding from Merck & Co. Jennifer Tjia has received consultant fees from CVS Health. The remaining authors have declared no conflicts of interest for this article. Author Contributions: Study concept and design: Kadoyama, Noble, Fromme, and Furuno. Acquisition of data: Kadoyama, Noble, McGregor, Ku, and Furuno. Analysis of data: Noble and Furuno. Interpretation of results: All authors. Preparation of initial draft of the manuscript: Kadoyama, Noble, Tjia, and Furuno. Critical review of the manuscript: All authors. Funding Source: This study was supported by the Oregon Clinical and Translational Research Institute funded by National Center for Advancing Translational Sciences award number UL1TR000128. Sponsor's Role: Funding for this project supported access to and infrastructure for study data.
Funding Information:
Conflict of Interest: Jon P. Furuno has received consultant fees from Merck & Co. and Shionogi & Co., Ltd. and research funding from Merck & Co. Jennifer Tjia has received consultant fees from CVS Health. The remaining authors have declared no conflicts of interest for this article.
Funding Information:
Funding Source: This study was supported by the Oregon Clinical and Translational Research Institute funded by National Center for Advancing Translational Sciences award number UL1TR000128.
Publisher Copyright:
© 2019 The American Geriatrics Society
PY - 2019/6
Y1 - 2019/6
N2 - OBJECTIVES: To quantify the frequency and type of medication decisions on discharge from the hospital to hospice care. DESIGN: Retrospective cohort study. SETTING: A 544-bed academic tertiary care hospital in Portland, Oregon. PARTICIPANTS: A total of 348 adult patients (age ≥18 y) discharged to hospice care between January 1, 2010, and December 31, 2016. MEASUREMENTS: Data were collected from an electronic repository of medical record data and a manual review of patients’ discharge summaries. Our outcomes of interest were the frequency and type of medication decisions documented in patients’ discharge summaries. Medication decisions were categorized as continuation, continuation but with changes in dose, route of administration, and/or frequency, discontinuation, and initiation of new medications. We also collected data on the frequency of patient/family in the participation of medication-related decisions. RESULTS: Patients were prescribed a mean of 7.1 medications (standard deviation [SD] = 4.8) on discharge to hospice care. The most prevalent medications prescribed on discharge were strong opioids (82.5%), anxiolytics/sedatives (62.9%), laxatives (57.5%), antiemetics (54.3%), and nonopioid analgesics (45.4%). However, only 67.8% (213/341) of patients who were prescribed an opioid on discharge to hospice care were also prescribed a laxative. Discharging providers made a mean of 15.0 decisions (SD = 7.2) per patient of which 28.5% were to continue medications without changes, 6.7% were to continue medications with changes, 30.3% were to initiate new medications, and 34.5% were to discontinue existing medications. Patients and/or family members were involved in medication decisions during 21.6% of discharges; patients were involved in 15.2% of decisions. CONCLUSION: Patients averaged more than 15 medication decisions on discharge to hospice care. However, it was rarely documented that patients and/or their families participated in these decisions. J Am Geriatr Soc, 2019.
AB - OBJECTIVES: To quantify the frequency and type of medication decisions on discharge from the hospital to hospice care. DESIGN: Retrospective cohort study. SETTING: A 544-bed academic tertiary care hospital in Portland, Oregon. PARTICIPANTS: A total of 348 adult patients (age ≥18 y) discharged to hospice care between January 1, 2010, and December 31, 2016. MEASUREMENTS: Data were collected from an electronic repository of medical record data and a manual review of patients’ discharge summaries. Our outcomes of interest were the frequency and type of medication decisions documented in patients’ discharge summaries. Medication decisions were categorized as continuation, continuation but with changes in dose, route of administration, and/or frequency, discontinuation, and initiation of new medications. We also collected data on the frequency of patient/family in the participation of medication-related decisions. RESULTS: Patients were prescribed a mean of 7.1 medications (standard deviation [SD] = 4.8) on discharge to hospice care. The most prevalent medications prescribed on discharge were strong opioids (82.5%), anxiolytics/sedatives (62.9%), laxatives (57.5%), antiemetics (54.3%), and nonopioid analgesics (45.4%). However, only 67.8% (213/341) of patients who were prescribed an opioid on discharge to hospice care were also prescribed a laxative. Discharging providers made a mean of 15.0 decisions (SD = 7.2) per patient of which 28.5% were to continue medications without changes, 6.7% were to continue medications with changes, 30.3% were to initiate new medications, and 34.5% were to discontinue existing medications. Patients and/or family members were involved in medication decisions during 21.6% of discharges; patients were involved in 15.2% of decisions. CONCLUSION: Patients averaged more than 15 medication decisions on discharge to hospice care. However, it was rarely documented that patients and/or their families participated in these decisions. J Am Geriatr Soc, 2019.
KW - discharge planning
KW - hospice care
KW - medication decisions
KW - transition to hospice
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U2 - 10.1111/jgs.15860
DO - 10.1111/jgs.15860
M3 - Article
C2 - 30854629
AN - SCOPUS:85062768589
SN - 0002-8614
VL - 67
SP - 1258
EP - 1262
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 6
ER -