Evaluation of Adequacy and Safety of Prescribed Pharmacotherapy for Hospitalized Patients Requiring Palliative Care

• Grant number: 23/13308-5
• Support Opportunities: Scholarships in Brazil - Doctorate
• Start date: August 01, 2025
• End date: March 31, 2027
• Field of knowledge: Health Sciences - Pharmacy
• Principal Investigator: Fabiana Rossi Varallo
• Grantee: Ivis Vinicius de Oliveira Martins
• Host Institution: Faculdade de Ciências Farmacêuticas de Ribeirão Preto (FCFRP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil

Abstract

Managing pharmacotherapy for patients in palliative care (PC) presents a challenge for healthcare professionals. The concurrent use of medications to control signs and symptoms, as well as to prevent clinical deterioration associated with morbidities and comorbidities, contributes to the inappropriate use of these healthcare technologies. Furthermore, polypharmacy contributes to the increased complexity of pharmacotherapy, inappropriate medication prescribing (IMP), and consequently, the occurrence of adverse drug events. To analyze the adequacy and safety of pharmacotherapy prescribed for PC needs in hospitals within the Hospital das Clínicas complex at the Ribeirão Preto Medical School - University of São Paulo (HCFMRP-USP). The research will be divided into three stages. The first stage (15 months) will involve scoping review to identify quality of life assessment instruments for PC patients, as well as comparative documentary analysis of prescription adequacy assessment criteria (identification of IMP) and the essential attributes of medications in PC. The second stage will encompass the actual epidemiological study. An analytical, observational, prospective, cross-sectional study will be conducted over 30 months. Hospitalized PC patients in the Emergency Unit and the Ribeirão Preto State Hospital will be interviewed, and their medical records will be reviewed to evaluate medical prescriptions at the time of admission and discharge, in order to analyze the mean difference in the absolute number of prescribed regular medications, IMP, and therapeutic regimen complexity. Furthermore, using the person-centered clinical method, intrahospital adverse drug events and related risk factors will be investigated. Lastly, in the third stage (three months), an economic evaluation of maintaining IMP in the prescriptions of PC patients with limited life expectancy or who have deceased will be conducted. Data obtained from the second and third stages will be compared between the studied hospitals. This study aims to demonstrate that the multidisciplinary approach of the PC team contributes to the reduction of polypharmacy prescribing, IMP, and therapeutic regimen complexity at hospital discharge. Furthermore, it aims to show that healthcare institutions' practices align with the organization of PC within the proposed national healthcare network