Deprescribing practices of medication in palliative patients in primary care

Abstract

Introduction Palliative patients have a high prevalence of polypharmacy (54-94%). This also increases the risk of receiving potentially inappropriate medications, which can negatively impact the quality of life. The aim of this study is to examine the use of certain potentially inappropriate medications in the last three months of life of palliative patients and identify factors associated with deprescribing. Method This study is a retrospective cohort study, using patient files from primary care practices. The primary outcome is differences in medication use, looking at calcium supplements, osteoporosis medication, lipid-modifying agents and antihypertensives, at 3 and 1 month before death. Secondary outcomes were possible factors associated with deprescribing and the presence of adverse events in the last month of life. Results 176 patients were included, of which 109 (62%) used at least one of the medications at 3 months before death and 35 (32%) discontinued medication at 1 month before death. A significant difference between patients who continued and patients who discontinued medication was seen in: main diagnosis 36,5% vs 60% had an oncological diagnosis (p= 0,024), primary care use in 4-6 months before death median of 3,0 vs 7,0 consults (p<0,001), palliative identified patients 23,0% vs 48,6% (p=0,007) and patients having advance care planning conversations 43,2% vs 65,7% (p=0,023). Discontinuing antihypertensives showed no significant difference in the risk of adverse events in the last month of life. Conclusion Many patients use potentially inappropriate medications in the last three months of life. Only in one third of patients some of these medications are deprescribed before the last month of life. Identifying the palliative phase and advance care planning seem to be positively associated with deprescribing practices.