Prescribing of pain medication in palliative care. A survey in general practice

• Published in: Pharmacoepidemiology and drug safety 2009-01, Vol.18 (1), p.16-23
• Main Authors: Borgsteede, Sander D., Deliens, Luc, Zuurmond, Wouter W. A., Schellevis, François G., Willems, Dick L., Van der Wal, Gerrit, van Eijk, Jacques Th. M.
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; analgesics; Analgesics, Non-Narcotic - therapeutic use; Analgesics, Opioid - adverse effects; Analgesics, Opioid - therapeutic use; Antiemetics - therapeutic use; Data Collection; drug prescribing; Family Practice - methods; Female; general practice; Home Care Services - statistics & numerical data; Humans; laxatives; Laxatives - therapeutic use; Male; Netherlands; opioids; Pain - drug therapy; Pain - etiology; pain management; palliative care; Palliative Care - methods; Practice Patterns, Physicians' - statistics & numerical data; Retrospective Studies; Time Factors
• ISSN: 1053-8569; 1099-1557
• DOI: 10.1002/pds.1678

Purpose To examine what pain and adjuvant medication is prescribed in palliative care patients at home in The Netherlands. Methods In a nationwide, representative, prospective study in general practice in The Netherlands, prescribed medication was registered in 95 general practices with a listed population of 374 070 patients. The GPs identified those who received palliative care in a retrospective survey of the 2169 patients who died within the 1‐year study period. We analysed the analgesics, laxatives and anti‐emetics that were prescribed during the last 3 months of life for these patients. Results The response rate of the survey was 74%. 425 patients received palliative care and 73% of them were prescribed pain medication: 55% a non‐opioid analgesic (paracetamol, NSAIDs), 21% a weak opioid (tramadol, codeine), and 51% a strong opioid. Relatively more younger than older patients were prescribed strong opioids, and more cancer than non‐cancer patients were prescribed an analgesic. During the last 3 months of life, the proportion of patients prescribed a non‐opioid or a weak opioid increased gradually. The proportion of patients prescribed a strong opioid increased considerably nearing the patient's death. About one third of the non‐cancer patients were prescribed strong opioids, mostly commencing in the last 2 weeks before death. In 48% of all patients with an opioid prescription, the GP did not prescribe a laxative. Conclusions Weak opioids and laxatives are frequently omitted from pain regimens in palliative care at home in The Netherlands. Copyright © 2008 John Wiley & Sons, Ltd.