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The financial costs of anticipatory prescribing: A retrospective observational study of prescribed, administered and wasted medications using community clinical records.

Authors
  • Morgan, Lloyd1
  • Barclay, Stephen1
  • Pollock, Kristian2
  • Massou, Efthalia1
  • Bowers, Ben1, 2, 3
  • 1 Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, England, UK.
  • 2 Nottingham Centre for the Advancement of Research into Supportive, Palliative and End of Life Care, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, England, UK.
  • 3 The Queen's Nursing Institute, London, UK.
Type
Published Article
Journal
Palliative medicine
Publication Date
Dec 01, 2023
Volume
37
Issue
10
Pages
1554–1561
Identifiers
DOI: 10.1177/02692163231198372
PMID: 37817429
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The prescribing of injectable end-of-life anticipatory medications ahead of possible need is recommended best practice. The financial costs of these medications have been little studied. To identify the costs of anticipatory medications prescribed, used and not used for patients approaching the end-of-life at home and in residential care. Retrospective observational study using general practitioner and community nursing clinical records. Data were collected from eleven general practitioner practices using the records of the 30 most recent deaths per practice. Patients were aged 18+ and died between 2017 and 2019 from any cause except trauma, sudden death or suicide. Anticipatory medications were prescribed to 167/329 patients, of which 164 were included in the analysis. Costs (GBP) were analysed both at patient-level and drug-level. Median anticipatory prescription cost was £43.17 (IQR: £38.98-£60.47, range £8.76-£229.82). Median administered (used) drug cost was £2.16 (IQR: £0.00-£12.09, range £0.00-£83.14). Median unused (wasted) drug cost was £41.47 (IQR: £29.15-£54.33, range £0.00-£195.36). Prescription, administered and unused costs were significantly higher for the 59 patients prescribed an anticipatory syringe driver. There were wide variations in the unused costs of individual drugs; Haloperidol and Cyclizine contributed 49% of total unused costs. The costs of prescribed and unused anticipatory medications were higher than previously reported but remain modest. Usage of prescriptions was lower than previously documented. There may be scope to reduce the quantity of vials that are routinely prescribed without adversely affecting care; further research is needed to investigate this possibility.

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