Doctors are increasingly looking after an ageing population with multiple health problems, leading to the extensive and complex use of medications in individual patients. Little is known about how many and what types of medicines patients are prescribed towards the end of life, either for the treatment of long-term health conditions or for symptom control in the final period of life. Understanding these issues is important if we are to develop successful ways of improving the quality of patient care and medicines use in such patients.
We will examine how the numbers and types of medicines prescribed by GPs change over the 12-month period prior to death, and examine what factors affect these patterns of medicines use, such as age, sex, social deprivation, different health problems and cause of death.
This work has the potential to benefit a large number of patients. It will help to identify patients who are at risk of experiencing inappropriate medicines towards the end of their life, and those who do or do not receive medication such as morphine for symptom control. It will help us design ways of improving the quality of prescribing and care for patients in the final months of life.
Polypharmacy, driven by an ageing, multimorbid population and a culture of single-condition guideline-driven prescribing, is becoming increasingly widespread in primary care. The evidence base for many medications is lacking in older, frail and multimorbid populations; benefits may be particularly questionable as the end of life approaches, especially where the intended gain from treatments may only be realised over several years. Little is known about patterns of polypharmacy and palliative medication towards the end of life in the general practice setting, and understanding these issues is central to developing and targeting medication optimisation strategies relevant to patients towards the end of life.
A retrospective cohort analysis will be conducted for all patients that died in 2009-2014. Prescribing data during the final 12 months of life will be studied. Descriptive analyses of temporal trends in polypharmacy and drug classes specific to symptom management (e.g. opioids) will be carried out, including modelling the association of prescribing change with cause of death.
This work will be a very important contribution to the literature on end-of-life care. It will generate an understanding of factors influencing prescribing towards the end of life, and improve the identification of individuals subject to suboptimal prescribing.
Rupert Payne - Chief Investigator - University of Bristol
Amelia Harshfield - Corresponding Applicant - University of Cambridge
Kirsty Rhodes - Collaborator - University of Cambridge
Stephen Barclay - Collaborator - University of Cambridge
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation