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Keywords:

  • analgesics;
  • drug prescribing;
  • general practice;
  • pain management;
  • laxatives;
  • palliative care;
  • opioids

Abstract

Purpose

To examine what pain and adjuvant medication is prescribed in palliative care patients at home in The Netherlands.

Methods

In a nationwide, representative, prospective study in general practice in The Netherlands, prescribed medication was registered in 95 general practices with a listed population of 374 070 patients. The GPs identified those who received palliative care in a retrospective survey of the 2169 patients who died within the 1-year study period. We analysed the analgesics, laxatives and anti-emetics that were prescribed during the last 3 months of life for these patients.

Results

The response rate of the survey was 74%. 425 patients received palliative care and 73% of them were prescribed pain medication: 55% a non-opioid analgesic (paracetamol, NSAIDs), 21% a weak opioid (tramadol, codeine), and 51% a strong opioid. Relatively more younger than older patients were prescribed strong opioids, and more cancer than non-cancer patients were prescribed an analgesic. During the last 3 months of life, the proportion of patients prescribed a non-opioid or a weak opioid increased gradually. The proportion of patients prescribed a strong opioid increased considerably nearing the patient's death. About one third of the non-cancer patients were prescribed strong opioids, mostly commencing in the last 2 weeks before death. In 48% of all patients with an opioid prescription, the GP did not prescribe a laxative.

Conclusions

Weak opioids and laxatives are frequently omitted from pain regimens in palliative care at home in The Netherlands. Copyright © 2008 John Wiley & Sons, Ltd.