Hostname: page-component-8448b6f56d-jr42d Total loading time: 0 Render date: 2024-04-18T06:18:42.768Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  21 October 2013

Marissa Araw ,
Andrzej Kozikowski ,
Cristina Sison ,
Tanveer Mir ,
Maha Saad ,
Lauren Corrado ,
Renee Pekmezaris  and
Gisele Wolf-Klein
Marissa Araw
Affiliation:
North Shore–Long Island Jewish Health System, Great Neck, New York
Andrzej Kozikowski
Affiliation:
North Shore–Long Island Jewish Health System, Great Neck, New York
Cristina Sison
Affiliation:
Feinstein Institute for Medical Research, Manhasset, New York
Tanveer Mir
Affiliation:
North Shore–Long Island Jewish Health System, Great Neck, New York Long Island Jewish Medical Center, New Hyde Park, New York
Maha Saad
Affiliation:
North Shore–Long Island Jewish Health System, Great Neck, New York St. Johns University College of Pharmacy and Health Sciences, Queens, New York Long Island Jewish Medical Center, New Hyde Park, New York
Lauren Corrado
Affiliation:
North Shore–Long Island Jewish Health System, Great Neck, New York Long Island Jewish Medical Center, New Hyde Park, New York
Renee Pekmezaris*
Affiliation:
North Shore–Long Island Jewish Health System, Great Neck, New York Albert Einstein College of Medicine, Bronx, New York Hofstra North Shore–Long Island Jewish School of Medicine, Hempstead, New York
Gisele Wolf-Klein
Affiliation:
North Shore–Long Island Jewish Health System, Great Neck, New York Albert Einstein College of Medicine, Bronx, New York Hofstra North Shore–Long Island Jewish School of Medicine, Hempstead, New York
*
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
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Palliative Care ConsultEnd-of-lifeDementiaPharmacy Costs
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 6 , December 2015 , pp. 1535 - 1540
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Alzheimer's Association (2012). Alzheimer's disease facts and figures. Chicago: Alzheimer's Association. Accessed October 22 at http://www.alz.org/alzheimers_disease_facts_figures.asp (Accessed on October 22, 2012).Google Scholar
Ahronheim, J.C., Morrison, R.S., Baskin, S.A., et al. (1996). Treatment of the dying in the acute care hospital: Advanced dementia and metastatic cancer. Archives of Internal Medicine, 156(18), 2094.CrossRefGoogle ScholarPubMed
Aminoff, B.Z. & Adunsky, A. (2005). Dying dementia patients: Too much suffering, too little palliation. American Journal of Hospice & Palliative Medicine, 22(5), 344–348.Google Scholar
Bendaly, E.A., Groves, J., Juliar, B., et al. (2008). Financial impact of palliative care consultation in a public hospital. Journal of Palliative Medicine, 11(10), 1304–1308.Google Scholar
Brayne, C., Gao, L., Dewey, M., et al. (2006). Dementia before death in ageing societies: The promise of prevention and the reality. PLOS Medicine, 3(10), e397.CrossRefGoogle ScholarPubMed
Di Giulio, P., Toscani, F., Villani, D., et al. (2008). Dying with advanced dementia in long-term care geriatric institutions: A retrospective study. Journal of Palliative Medicine, 11(7), 1023–1028.Google Scholar
Franks, P.J., Salisbury, C., Bosanquet, N., et al. (2000). The level of need for palliative care: A systematic review of the literature. Palliative Medicine, 14(2), 93–104.Google Scholar
Gearing, R.E., Mian, I.A., Barber, J., et al. (2006). A methodology for conducting retrospective chart-review research in child and adolescent psychiatry. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 15(3), 126.Google ScholarPubMed
Goldfeld, K.S., Stevenson, D.G., Hamel, M.B., et al. (2011). Medicare expenditures among nursing home residents with advanced dementia. Archives of Internal Medicine, 171(9), 824–830.CrossRefGoogle ScholarPubMed
Herlitz, J., Eek, M., Engdahl, J., et al. (2003). Factors at resuscitation and outcome among patients suffering from out of hospital cardiac arrest in relation to age. Resuscitation, 58(3), 309–317.Google Scholar
Le, B.H.C. & Watt, J.N. (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), 855–860.CrossRefGoogle ScholarPubMed
Manfredi, P.L., Morrison, R.S., Morris, J., et al. (2000). Palliative care consultations: How do they impact the care of hospitalized patients? Journal of Pain and Symptom Management, 20(3), 166–173.CrossRefGoogle ScholarPubMed
McCarthy, M., Addington-Hall, J. & Altmann, D. (1997). The experience of dying with dementia: A retrospective study. International Journal of Geriatric Psychiatry, 12(3), 404–409.Google Scholar
Michel, J.P., Pautex, S., Zekry, D., et al. (2002). End-of-life care of persons with dementia. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 57(10), M640–M644.CrossRefGoogle ScholarPubMed
Mitchell, S.L., Kiely, D.K. & Hamel, M.B. (2004). Dying with advanced dementia in the nursing home. Archives of Internal Medicine, 164(3), 321–326.Google Scholar
Mitchell, S.L., Teno, J.M., Kiely, D.K., et al. (2009). The clinical course of advanced dementia. The New England Journal of Medicine, 361(16), 1529–1538.Google Scholar
Morrison, R.S., Penrod, J.D., Cassel, J.B., et al. (2008). Cost savings associated with U,S, hospital palliative care consultation programs. Archives of Internal Medicine, 168(16), 1783.Google Scholar
Morrison, R.S., Dietrich, J., Ladwig, S., et al. (2011). Palliative care consultation teams cut hospital costs for Medicaid beneficiaries. Health Affairs, 30(3), 454–463.CrossRefGoogle ScholarPubMed
Pan, L., Fergusson, D., Schweitzer, I., et al. (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), 918–923.CrossRefGoogle ScholarPubMed
Prince, M. & Jackson, J. (2009). Alzheimer's Disease International World Alzheimer's Report, 2009. Alzheimer's Disease International, 1–96.Google Scholar
Sachs, G.A., Shega, J.W. & Cox-Hayley, D. (2004). Barriers to excellent end-of-life care for patients with dementia. Journal of General Internal Medicine, 19(10), 1057–1063.Google Scholar
Sampson, E., Ritchie, C., Lai, R., et al. (2005). A systematic review of the scientific evidence for the efficacy of a palliative care approach in advanced dementia. International Psychogeriatrics, 17(1), 31–40.CrossRefGoogle ScholarPubMed
Sampson, E.L., Gould, V., Lee, D., et al. (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), 187–189.CrossRefGoogle ScholarPubMed
Sampson, E.L., Jones, L., Thuné-Boyle, I.C.V., et al. (2011). Palliative assessment and advance care planning in severe dementia: An exploratory randomized controlled trial of a complex intervention. Palliative Medicine, 25(3), 197–209.Google Scholar
Shuster, J.L. Jr. (1998). Delirium, confusion, and agitation at the end of life. Journal of Palliative Medicine, 1(2), 177–186.Google Scholar
Smith, T.J., Coyne, P., Cassel, B., et al. (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), 699–705.Google Scholar
Sorrell, J.M. (2010). Use of feeding tubes in patients with advanced dementia: Are we doing harm? Journal of Psychosocial Nursing and Mental Health Services, 48(5), 15–18.Google Scholar
Temel, J.S., Greer, J.A., Muzikansky, A., et al. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. The New England Journal of Medicine, 363(8), 733–742.Google Scholar
Volicer, L. (2007). Goals of care in advanced dementia: Quality of life, dignity and comfort. The Journal of Nutrition, Health and Aging, 11(6), 481–481.Google Scholar