Variation in pain medication use in end-of-life care.
BACKGROUND
Pain is a common and distressing symptom at the end of life that medications can help relieve. We sought to explore variation in approaches to pharmaceutical management of pain among hospice-eligible patients and to determine if variation was explained by patient or site of care characteristics. Variation in medication use may suggest areas for best practices or quality improvement in medication use in end-of-life care.


METHODS
We conducted a secondary analysis of randomized trial data, examining use of five medication classes: opiates, nonsteroidal anti-inflammatory drugs (NSAIDs), adjuvant pain medications (tricyclics and antiseizure), stimulants, and antianxiety medications in 16 study sites nationwide. Descriptive statistics were generated for patient-level data and by site. Unadjusted and adjusted odds ratios were calculated to compare patient and location of care characteristics with each medication class use by site.


RESULTS
We found variation in medication use was not predicted by most patient characteristics or location of care (home versus facility). Use of all types of pain medications decreased with age (odds ratio [OR] 0.75 [0.63-0.90]). Medication use varied between sites: a range of 14%-83% of patients were on different types of opiates, 0%-40% on NSAIDS, 20%-69% on benzodiazepines, 0%-25% on adjuvant medications, and 0%-23% were on acetaminophen at any time during the data collection period.


CONCLUSIONS
Pain and adjuvant medication use differs widely by site of care. Further research is needed to determine the extent to which provider and patient choice contribute to prescribing variation, and to explore associations between patient symptoms, medication variation, and patient care quality.
Zerzan
Judy
J
Division of General Internal Medicine, University of Colorado Denver, Aurora, Colorado 80045, USA. Judy.Zerzan@ucdenver.edu
Benton
Kathryn
K
Linnebur
Sunny
S
O'Bryant
Cindy
C
Kutner
Jean
J
D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000209:etiology* / Q000517:prevention & control*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D017408:Guidelines as Topic; D006801:Humans; D008405:Massage; D010146:Pain / Q000188:drug therapy / Q000523:psychology*; D059408:Pain Management; D010166:Palliative Care / Q000706:statistics & numerical data*
D014151:Anti-Anxiety Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal