Palliative and Supportive Care

Research Article

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

Marissa Arawa1, Andrzej Kozikowskia1, Cristina Sisona4, Tanveer Mira1a6, Maha Saada1a5a6, Lauren Corradoa1a6, Renee Pekmezarisa1a2a3 c1 and Gisele Wolf-Kleina1a2a3

a1 North Shore–Long Island Jewish Health System, Great Neck, New York

a2 Albert Einstein College of Medicine, Bronx, New York

a3 Hofstra North Shore–Long Island Jewish School of Medicine, Hempstead, New York

a4 Feinstein Institute for Medical Research, Manhasset, New York

a5 St. Johns University College of Pharmacy and Health Sciences, Queens, New York

a6 Long Island Jewish Medical Center, New Hyde Park, New York

Abstract

Objective: 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.

(Received March 26 2013)

(Accepted June 01 2013)

Keywords

  • Palliative Care Consult;
  • End-of-life;
  • Dementia;
  • Pharmacy Costs

Correspondence

c1 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