Impact of a new palliative care consultation team on opioid prescription in a University Hospital

被引：8

作者：

Centeno C. ^{[1
]}

Portela M.A. ^{[1
]}

Noguera A. ^{[2
]}

Idoate A. ^{[3
]}

Rubiales Á.S. ^{[4
]}

机构：

[1] Unidad de Medicina Paliativa Y Control de Síntomas, Clínica Universidad de Navarra, Pamplona

[2] Unidad de Medicina Paliativa, Hospital Laguna, Madrid

[3] Departamento de Farmacia, Clínica Universidad de Navarra, Pamplona

[4] Unidad de Oncología, Hospital Universitario del Río Hortega, Valladolid

来源：

BMC Palliative Care | / 8卷 / 1期

关键词：

Morphine; Palliative Care; Oxycodone; Define Daily Dose; Opioid Prescription;

D O I：

10.1186/1472-684X-8-2

中图分类号：

学科分类号：

摘要：

Background. There are no validated measuring tools to gauge the effectiveness of a Hospital Palliative Care Consultation Team (PCCT). One way would be to consider its effect on the consumption of opioids expressed in total amounts and different formulations administered. We perform this study to evaluate the impact of a hospital PCCT on the trends of opioid prescription in a University Hospital. Methods. A seven year retrospective study on opioid prescription was carried out in the Clínica Universidad de Navarra. The period includes three years before and three years after the PCCT was implemented. Prescription was analysed calculating yearly the Defined Daily Dose (DDD) adjusted to 1000 hospital stays (DDD/1000HS). Indicators considered were the proportion of patients treated using opioids compared to the total estimated in need of treatment (rate of effectiveness) and the proportion of patients potentially requiring opioids but not treated who were incorporated into the treatment group (rate of improvement). Results. From 2001 to 2007, total opioid prescription was low in non-oncology Departments (range: 69-110 DDD/1000HS) while parenteral morphine and fentanyl did not register any changes. In the same period of time, total opioid prescription increased in the Oncology Department from 240 to 558 DDD/1000HS. The rate of effectiveness in the three years prior to the implantation of the consultation team was 64% and in the three following years rose to 87%. The rate of improvement prior to the palliative care consultation team was 43% and in the three following years was 64%. A change in opioid prescription was registered after the implementation of the PCCT resulting in an increase in the prescription of parenteral morphine and methadone and a decrease in transdermal fentanyl. Conclusion. Implementation of a PCCT in a University Hospital is associated with a higher and more adequate use of opioids. © 2009 Centeno et al; licensee BioMed Central Ltd.

引用

共 29 条

[1]

Health Organization W., Cancer pain relief and palliative care, WHO Technical Report Series, 804, (1990)

[2]

Cleeland C.S., Gonin R., Hatfield A.K., Edmonson J.H., Blum R.H., Stewart J.A., Pandya K.J., Pain and its treatment in outpatients with metastasic cancer, N Engl J Med, 330, pp. 592-6, (1994)

[3]

Paregeom K.L., Hailey B.J., Barriers to effective cancer pain management: A review of the literature, J Pain Symptom Manage, 109, pp. 281-3, (1999)

[4]

Carvajal A., Garcia Del Pozo J., Martin Arias L.H., Martin De Diego I., Rueda A.M., Caro-Patan T., Alvarez Requejo A., Changes in the pattern of opioid analgesic consumption in Spain, Med Clin (Barc), 109, pp. 281-3, (1997)

[5]

Higginson I.J., Hearn J., A multicenter evaluation of cancer pain control by palliative care teams, J Pain Sympton Manage, 14, pp. 29-35, (1997)

[6]

Strohscheer I., Verebes J., Samonigg H., Implementation of a Palliative Care Team in an Austrian University Hospital, Support Care Cancer, 14, pp. 795-801, (2006)

[7]

Virik K., Glare P., Profile and evaluation of a palliative medicine consultation service within a tertiary teaching hospital in Sydney, J Pain Symptom Manage, 23, pp. 17-25, (2002)

[8]

Weissmann D.E., Consultations in palliative medicine, Arch Intern Med, 157, pp. 733-7, (1997)

[9]

Cintron A., Meier D., The palliative care consult team, Textbook of Palliative Medicine, pp. 259-65, (2006)

[10]

Palliative Care in Community Hospitals in Scotland a Framework for Good Practice 2003. Scottish Association of Community Hospitals and Scottish Partnership for Palliative Care

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