Prescribing of pain medication in palliative care. A survey in general practice

Authors

  • Sander D. Borgsteede,

    Corresponding author
    1. VU University Medical Center, Department of Public and Occupational Health, EMGO Institute, Amsterdam, The Netherlands
    2. VU University Medical Center, Department of Clinical Pharmacology and Pharmacy, Amsterdam, The Netherlands
    • Department of Public and Occupational Health, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
    Search for more papers by this author
    • Pharmacist.

  • Luc Deliens,

    1. VU University Medical Center, Department of Public and Occupational Health, EMGO Institute, Amsterdam, The Netherlands
    2. Vrije Universiteit Brussel, End-of-Life Care Research Group, Brussels, Belgium
    Search for more papers by this author
    • Medical sociologist.

  • Wouter W. A. Zuurmond,

    1. VU University Medical Center, Department of Anesthesiology/Pain Clinics, Amsterdam, The Netherlands
    Search for more papers by this author
    • Anaesthesiologist.

  • François G. Schellevis,

    1. VU University Medical Center, Department of General Practice, EMGO Institute, Amsterdam, The Netherlands
    2. Netherlands Institute for Health Services Research, Utrecht, The Netherlands
    Search for more papers by this author
    • General practitioner.

  • Dick L. Willems,

    1. Academic Medical Center, Department of General Practice, University of Amsterdam, Amsterdam, The Netherlands
    Search for more papers by this author
    • General practitioner and ethicist.

  • Gerrit Van der Wal,

    1. VU University Medical Center, Department of Public and Occupational Health, EMGO Institute, Amsterdam, The Netherlands
    Search for more papers by this author
    • General practitioner.

  • Jacques Th. M. van Eijk

    1. Department of Health Care Studies/Medical Sociology, University of Maastricht, Maastricht, The Netherlands
    Search for more papers by this author
    • Medical sociologist end epidemiologist.


  • No conflict of interest was declared.

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.

Ancillary