Changes in End-of-Life Symptom Management Prescribing among Long-Term Care Residents during COVID-19

TitleChanges in End-of-Life Symptom Management Prescribing among Long-Term Care Residents during COVID-19
Publication TypeJournal Article
Year of Publication2024
AuthorsFremont D., Roberts R.L, Webber C., Clarke A.E, Milani C., Isenberg S.R, Bush S.H, Kobewka D., Turcotte L., Howard M., Boese K., Arya A., Robert B., Sinnarajah A., Simon J.E, Lau J., Qureshi D., Downar J., Tanuseputro P.
JournalJ Am Med Dir Assoc
Volume25
Issue6
Pagination104955
Date PublishedJun
ISBN Number1538-9375 (Electronic)<br/>1525-8610 (Linking)
Accession Number38438112
Keywords*COVID-19/epidemiology, *Long-Term Care, *Nursing Homes, *SARS-CoV-2, *Terminal Care, administrative health data, Aged, Aged, 80 and over, COVID-19, end-of-life, Female, health system measures, Humans, Long-Term Care, Male, Medications, Ontario/epidemiology, Pandemics, Practice Patterns, Physicians'/statistics & numerical data, Retrospective Studies
Abstract

OBJECTIVE: To examine changes in the prescribing of end-of-life symptom management medications in long-term care (LTC) homes during the COVID-19 pandemic. DESIGN: Retrospective cohort study using routinely collected health administrative data in Ontario, Canada. SETTING AND PARTICIPANTS: We included all individuals who died in LTC homes between January 1, 2017, and March 31, 2021. We separated the study into 2 periods: before COVID-19 (January 1, 2017, to March 17, 2020) and during COVID-19 (March 18, 2020, to March 31, 2021). METHODS: For each LTC home, we measured the percentage of residents who died before and during COVID-19 who had a subcutaneous symptom management medication prescription in their last 14 days of life. We grouped LTC homes into quintiles based on their mean prescribing rates before COVID-19, and examined changes in prescribing during COVID-19 and COVID-19 outcomes across quintiles. RESULTS: We captured 75,438 LTC residents who died in Ontario's 626 LTC homes during the entire study period, with 19,522 (25.9%) dying during COVID-19. The mean prescribing rate during COVID-19 ranged from 46.9% to 79.4% between the lowest and highest prescribing quintiles. During COVID-19, the mean prescribing rate in the lowest prescribing quintile increased by 9.6% compared to before COVID-19. Compared to LTC homes in the highest prescribing quintile, homes in the lowest prescribing quintile experienced the highest proportion of COVID-19 outbreaks (73.4% vs 50.0%), the largest mean outbreak intensity (0.27 vs 0.09 cases/bed), the highest mean total days with a COVID-19 outbreak (72.7 vs 24.2 days), and the greatest proportion of decedents who were transferred and died outside of LTC (22.1% vs 8.6%). CONCLUSIONS AND IMPLICATIONS: LTC homes in Ontario had wide variations in the prescribing rates of end-of-life symptom management medications before and during COVID-19. Homes in the lower prescribing quintiles had more COVID-19 cases per bed and days spent in an outbreak.

DOI10.1016/j.jamda.2024.01.024
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Disclosure The authors declare no conflicts of interest.