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Prescribing for comorbid disease in a palliative population: Focus on the use of lipid-lowering medications

Journal Article


Abstract


  • Background: The balance of benefit versus burden of ongoing treatments for comorbid disease in palliative populations as death approaches needs careful consideration given their particular susceptibility to adverse drug effects. Aim: To provide descriptive data regarding the medications being prescribed to patients who have a life-limiting illness at the time of referral to a palliative care service in regional Australia, with particular focus on lipid-lowering medications. Methods: A prospective case note review of 203 patients reporting the number of medications prescribed and, for lipid-lowering medications, the indication and level of prevention sought (primary, secondary, tertiary). Rates were compared by performance status, disease phase and comorbidity burden. Results: Mean number of regular medications prescribed was 7.2, with higher rates observed in those patients with a non-malignant primary diagnosis (rate ratio 1.28, confidence interval (CI) 1.11-1.50) or poorer performance status (rate ratio 1.37, CI 1.11-1.69) and lower rates for those in the terminal phase of disease (rate ratio 0.48, CI 0.30-0.76). Over one fifth of patients were prescribed a lipid-lowering medication, and two fifths of these prescriptions were for primary prevention of cardiovascular disease. Patients in the highest quartile of Charlson Comorbidity Index score were 4.6 (CI 2.06-10.09) times more likely to be prescribed a lipid-lowering medication than those in the lowest quartile. Conclusions: Polypharmacy is prevalent for this group of patients, placing them at high risk of drug-drug and drug-host interactions. Prescribing may be driven by risk factors and disease guidelines rather than a rational, patient-centred approach. �� 2013 Royal Australasian College of Physicians.

Publication Date


  • 2014

Citation


  • Russell, B. J., Rowett, D., Abernethy, A. P., & Currow, D. C. (2014). Prescribing for comorbid disease in a palliative population: Focus on the use of lipid-lowering medications. Internal Medicine Journal, 44(2), 177-184. doi:10.1111/imj.12340

Scopus Eid


  • 2-s2.0-84894095383

Start Page


  • 177

End Page


  • 184

Volume


  • 44

Issue


  • 2

Place Of Publication


Abstract


  • Background: The balance of benefit versus burden of ongoing treatments for comorbid disease in palliative populations as death approaches needs careful consideration given their particular susceptibility to adverse drug effects. Aim: To provide descriptive data regarding the medications being prescribed to patients who have a life-limiting illness at the time of referral to a palliative care service in regional Australia, with particular focus on lipid-lowering medications. Methods: A prospective case note review of 203 patients reporting the number of medications prescribed and, for lipid-lowering medications, the indication and level of prevention sought (primary, secondary, tertiary). Rates were compared by performance status, disease phase and comorbidity burden. Results: Mean number of regular medications prescribed was 7.2, with higher rates observed in those patients with a non-malignant primary diagnosis (rate ratio 1.28, confidence interval (CI) 1.11-1.50) or poorer performance status (rate ratio 1.37, CI 1.11-1.69) and lower rates for those in the terminal phase of disease (rate ratio 0.48, CI 0.30-0.76). Over one fifth of patients were prescribed a lipid-lowering medication, and two fifths of these prescriptions were for primary prevention of cardiovascular disease. Patients in the highest quartile of Charlson Comorbidity Index score were 4.6 (CI 2.06-10.09) times more likely to be prescribed a lipid-lowering medication than those in the lowest quartile. Conclusions: Polypharmacy is prevalent for this group of patients, placing them at high risk of drug-drug and drug-host interactions. Prescribing may be driven by risk factors and disease guidelines rather than a rational, patient-centred approach. �� 2013 Royal Australasian College of Physicians.

Publication Date


  • 2014

Citation


  • Russell, B. J., Rowett, D., Abernethy, A. P., & Currow, D. C. (2014). Prescribing for comorbid disease in a palliative population: Focus on the use of lipid-lowering medications. Internal Medicine Journal, 44(2), 177-184. doi:10.1111/imj.12340

Scopus Eid


  • 2-s2.0-84894095383

Start Page


  • 177

End Page


  • 184

Volume


  • 44

Issue


  • 2

Place Of Publication