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Does a palliative care consult decrease the cost of caring for hospitalized patients with dementia?

  • Marissa Araw (a1), Andrzej Kozikowski (a1), Cristina Sison (a2), Tanveer Mir (a1) (a3), Maha Saad (a1) (a4) (a3), Lauren Corrado (a1) (a3), Renee Pekmezaris (a1) (a5) (a6) and Gisele Wolf-Klein (a1) (a5) (a6)
  • DOI: http://dx.doi.org/10.1017/S1478951513000795
  • Published online: 21 October 2013
Abstract
AbstractObjective:

Advanced dementia (AD) is a terminal disease. Palliative care is increasingly becoming of critical importance for patients afflicted with AD. The primary objective of this study was to compare pharmacy cost before and after a palliative care consultation (PCC) in patients with end-stage dementia. A secondary objective was to investigate the cost of particular types of medication before and after a PCC.

Method:

This was a retrospective study of 60 hospitalized patients with end-stage dementia at a large academic tertiary care hospital from January 1, 2010 to October 1, 2011, in order to investigate pharmacy costs before and after a PCC. In addition to demographics, we carried out a comparison of the average daily pharmacy cost and comparison of the proportion of subjects taking each medication type (cardiac, analgesics, antibiotics, antipsychotics and antiemetics) before and after a PCC.

Results:

There was a significant decrease in overall average daily pharmacy cost from before to after a PCC ($31.16 ± 24.71 vs. $20.83 ± 19.56; p < 0.003). There was also a significant difference in the proportion of subjects taking analgesics before and after PCC (55 vs. 73.3%; p < 0.009), with a significant average daily analgesic cost rise from pre- to post-PCC: $1.36 ± 5.07 (median = $0.05) versus. $2.35 ± 5.35 (median = $0.71), respectively, p < 0.011; average daily antiemetics cost showed a moderate increase from pre- to post-PCC: $0.08 ± 0.37 (median = $0) versus $0.23 ± 0.75 (median = $0), respectively, p < 0.047.

Significance of results:

Our findings indicate that PCC is associated with overall decreased medication cost in hospitalized AD patients. Additionally, receiving a PCC was related to greater use of pain medications in hospitalized dementia patients. Our study corroborates the benefits of palliative care team intervention in managing elderly hospitalized dementia patients.

Copyright
Corresponding author
Address correspondence and reprint requests to: Renee Pekmezaris, North Shore–Long Island Jewish Health System, 175 Community Drive, Second Floor, Great Neck, New York 11021. E-mail: rpekmeza@nshs.edu
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J.C. Ahronheim , R.S. Morrison , S.A. Baskin , (1996). Treatment of the dying in the acute care hospital: Advanced dementia and metastatic cancer. Archives of Internal Medicine, 156(18), 2094.

B.Z. Aminoff & A. Adunsky (2005). Dying dementia patients: Too much suffering, too little palliation. American Journal of Hospice & Palliative Medicine, 22(5), 344348.

E.A. Bendaly , J. Groves , B. Juliar , (2008). Financial impact of palliative care consultation in a public hospital. Journal of Palliative Medicine, 11(10), 13041308.

C. Brayne , L. Gao , M. Dewey , (2006). Dementia before death in ageing societies: The promise of prevention and the reality. PLOS Medicine, 3(10), e397.

P. Di Giulio , F. Toscani , D. Villani , (2008). Dying with advanced dementia in long-term care geriatric institutions: A retrospective study. Journal of Palliative Medicine, 11(7), 10231028.

P.J. Franks , C. Salisbury , N. Bosanquet , (2000). The level of need for palliative care: A systematic review of the literature. Palliative Medicine, 14(2), 93104.

K.S. Goldfeld , D.G. Stevenson , M.B. Hamel , (2011). Medicare expenditures among nursing home residents with advanced dementia. Archives of Internal Medicine, 171(9), 824830.

J. Herlitz , M. Eek , J. Engdahl , (2003). Factors at resuscitation and outcome among patients suffering from out of hospital cardiac arrest in relation to age. Resuscitation, 58(3), 309317.

B.H.C. Le & J.N. Watt (2010). Care of the dying in Australia's busiest hospital: Benefits of palliative care consultation and methods to enhance access. Journal of Palliative Medicine, 13(7), 855860.

P.L. Manfredi , R.S. Morrison , J. Morris , (2000). Palliative care consultations: How do they impact the care of hospitalized patients? Journal of Pain and Symptom Management, 20(3), 166173.

M. McCarthy , J. Addington-Hall & D. Altmann (1997). The experience of dying with dementia: A retrospective study. International Journal of Geriatric Psychiatry, 12(3), 404409.

J.P. Michel , S. Pautex , D. Zekry , (2002). End-of-life care of persons with dementia. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 57(10), M640M644.

S.L. Mitchell , D.K. Kiely & M.B. Hamel (2004). Dying with advanced dementia in the nursing home. Archives of Internal Medicine, 164(3), 321326.

S.L. Mitchell , J.M. Teno , D.K. Kiely , (2009). The clinical course of advanced dementia. The New England Journal of Medicine, 361(16), 15291538.

R.S. Morrison , J.D. Penrod , J.B. Cassel , (2008). Cost savings associated with U,S, hospital palliative care consultation programs. Archives of Internal Medicine, 168(16), 1783.

R.S. Morrison , J. Dietrich , S. Ladwig , (2011). Palliative care consultation teams cut hospital costs for Medicaid beneficiaries. Health Affairs, 30(3), 454463.

L. Pan , D. Fergusson , I. Schweitzer , (2005). Ensuring high accuracy of data abstracted from patient charts: The use of a standardized medical record as a training tool. Journal of Clinical Epidemiology, 58(9), 918923.

G.A. Sachs , J.W. Shega & D. Cox-Hayley (2004). Barriers to excellent end-of-life care for patients with dementia. Journal of General Internal Medicine, 19(10), 10571063.

E.L. Sampson , V. Gould , D. Lee , (2006). Differences in care received by patients with and without dementia who died during acute hospital admission: A retrospective case note study. Age and Ageing, 35(2), 187189.

E.L. Sampson , L. Jones , I.C.V. Thuné-Boyle , (2011). Palliative assessment and advance care planning in severe dementia: An exploratory randomized controlled trial of a complex intervention. Palliative Medicine, 25(3), 197209.

J.L. Shuster Jr. (1998). Delirium, confusion, and agitation at the end of life. Journal of Palliative Medicine, 1(2), 177186.

T.J. Smith , P. Coyne , B. Cassel , (2003). A high-volume specialist palliative care unit and team may reduce in-hospital end-of-life care costs. Journal of Palliative Medicine, 6(5), 699705.

J.M. Sorrell (2010). Use of feeding tubes in patients with advanced dementia: Are we doing harm? Journal of Psychosocial Nursing and Mental Health Services, 48(5), 1518.

J.S. Temel , J.A. Greer , A. Muzikansky , (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. The New England Journal of Medicine, 363(8), 733742.

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Palliative & Supportive Care
  • ISSN: 1478-9515
  • EISSN: 1478-9523
  • URL: /core/journals/palliative-and-supportive-care
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