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Home-Based Prescribed Pulmonary Exercise in Patients with Stable Chronic Obstructive Pulmonary Disease

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Deprescribing in the Home Palliative Setting.

Yifan Li¹, Ciara M Whelan², Amna F Husain³

¹Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

Journal of Palliative Medicine

|December 16, 2020

Summary

Deprescribing noncomfort medications is associated with a higher number of these drugs in patients receiving home palliative care. This highlights opportunities to align medication regimens with patient comfort goals.

Keywords:

deprescribing home palliative noncomfort medications polypharmacy

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Area of Science:

Palliative Care Medicine
Geriatric Pharmacology
Health Services Research

Background:

When patient goals shift to comfort, treatment should prioritize symptom relief over life prolongation.
Home-visiting palliative care aims to manage symptoms and improve quality of life for patients with serious illnesses.

Purpose of the Study:

To investigate the association between the number of noncomfort medications and deprescribing in patients managed by home-visiting palliative care physicians.
To identify factors influencing deprescribing in the palliative care setting.

Main Methods:

Retrospective chart review of 80 patients receiving home-visiting palliative care.
Medications classified as comfort, possibly comfort, or definitely not for comfort (DNC).
Analysis of associations between deprescribing and variables like DNC medication count, Palliative Performance Scale (PPS), and encounters.

Main Results:

Deprescribing occurred in 44% of patients within 60 days.
A higher median number of DNC medications (3 vs. 0) and proportion (29% vs. 15%) were observed in the deprescribed group.
Significant association found between deprescribing and increased DNC medications (p < 0.001).

Conclusions:

Deprescribing in home palliative care is linked to a greater number and proportion of noncomfort medications at initial assessment.
Significant variation in deprescribing rates exists among different home-visiting palliative care providers.