Effectiveness of a Person-Centered Prescription Model in Hospitalized Older People at the End of Life According to Their Disease Trajectories and Frailty Index

Alexander Ferro-Uriguen (), Idoia Beobide-Telleria, Javier Gil-Goikouria, Petra Teresa Peña-Labour, Andrea Díaz-Vila, Arlovia Teresa Herasme-Grullón and Enrique Echevarría-Orella
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Alexander Ferro-Uriguen: Department of Pharmacy, Ricardo Bermingham Hospital—Matia Foundation, 20018 Donostia, Spain
Idoia Beobide-Telleria: Department of Pharmacy, Ricardo Bermingham Hospital—Matia Foundation, 20018 Donostia, Spain
Javier Gil-Goikouria: Department of Physiology, University of the Basque Country (UPV/EHU), 48940 Bilbao, Spain
Petra Teresa Peña-Labour: Department of Geriatrics, Ricardo Bermingham Hospital—Matia Foundation, 20018 Donostia, Spain
Andrea Díaz-Vila: Department of Geriatrics, Ricardo Bermingham Hospital—Matia Foundation, 20018 Donostia, Spain
Arlovia Teresa Herasme-Grullón: Department of Geriatrics, Ricardo Bermingham Hospital—Matia Foundation, 20018 Donostia, Spain
Enrique Echevarría-Orella: Department of Physiology, University of the Basque Country (UPV/EHU), 48940 Bilbao, Spain

IJERPH, 2023, vol. 20, issue 4, 1-11

Abstract: This study aimed to comparatively analyze the effect of the person-centered prescription (PCP) model on pharmacotherapeutic indicators and the costs of pharmacological treatment between a dementia-like trajectory and an end-stage organ failure trajectory, and two states of frailty (cut-off point 0.5). A randomized controlled trial was conducted with patients aged ≥65 years admitted to a subacute hospital and identified by the Necessity of Palliative Care test to require palliative care. Data were collected from February 2018 to February 2020. Variables assessed included sociodemographic, clinical, degree-of-frailty, and several pharmacotherapeutic indicators and the 28-day medication cost. Fifty-five patients with dementia-like trajectory and 26 with organ failure trajectory were recruited observing significant differences at hospital admission in the mean number of medications (7.6 vs. 9.7; p < 0.004), the proportion of people on more than 10 medications (20.0% vs. 53.8%; p < 0.002), the number of drug–drug interactions (2.7 vs. 5.1; p < 0.006), and the Medication Regimen Complexity Index (MRCI) (25.7 vs. 33.4; p < 0.006), respectively. Also, regarding dementia-like patients, after application of the PCP model, these patients improved significantly in the intervention group compared to the control group in the mean number of chronic medications, STOPP Frail Criteria, MRCI and the 28-day cost of regular medications ( p < 0.05) between admission and discharge. As for the PCP effect on the control and the intervention group at the end-stage organ failure, we did not observe statistically significant differences. On the other hand, when the effect of the PCP model on different degrees of frailty was evaluated, no unequal behavior was observed.

Keywords: end of life; frail older adults; palliative medicine; deprescribing; patient-centered prescription model (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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