Impact of outpatient palliative care on costs and prescription of potentially inappropriate medicines among frail older people and individuals diagnosed with cancer

• Grant number: 23/02677-0
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: June 01, 2023
• End date: May 31, 2024
• Field of knowledge: Health Sciences - Pharmacy - Medicines Analysis and Control
• Principal Investigator: Fabiana Rossi Varallo
• Grantee: Bruno Vieira Felix da Silva
• Host Institution: Faculdade de Ciências Farmacêuticas de Ribeirão Preto (FCFRP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil

Abstract

Polypharmacy is frequent in patients undergoing palliative care (PC) because, in addition to the disease that threatens the continuity of life, these individuals also live with multiple comorbidities. This fact makes the management of pharmacotherapy a challenge for health professionals, which can contribute to the unsafe and inappropriate use of medications. The use of tools for the prescription of essential medicines and for the detection of potentially inappropriate medicines (PIM) helps in medical decision-making for controlling of signs and symptoms and in the deprescription of these health technologies. Thus, the present study aims to evaluate the impact of outpatient palliative care on the costs and prescription of PIM for frail older people and individuals diagnosed with cancer. Therefore, an analytical, observational, cross-sectional study will be conducted with retrospective data collection. The medical records of individuals aged 18 years or over who begin treatment (new cases) at the outpatient clinic specialized in PC at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP, from January 1st to December 31st, 2022, will be considered eligible. After inclusion in the service, the medical records of the participants will be reviewed for a period of 12 months for sociodemographic, clinical and pharmacotherapeutic characterization. The primary predictor variables will include mean number of prescribed regular medication, essential medicines, and PIM. The secondary predictor variable will be the 28 day-cost of the PIM prescription, from the perspective of the health system. The prescriptions of the first attendance at the outpatient clinic (t0) will be compared with those of the last attendance (t1) to assess the impact. To identify essential medicines, the 22nd model list of the World Health Organization will be used. For the detection of PIM in frail older people and patients diagnosed with cancer, STOPPFRAIL-version 2 and OncPal instruments will be applied, respectively. It is expected, with this study, to verify that outpatient palliative care reduces costs, polypharmacy, and PIM prescription, as well as increases the use of essential medicines.