title: Does a palliative care consult decrease the cost of caring for hospitalized patients with dementia?
abstract: OBJECTIVE
  Advanced dementia (AD) is a terminal disease. Palliative care is increasingly becoming of critical importance for patients afflicted with AD. The primary objective of this study was to compare pharmacy cost before and after a palliative care consultation (PCC) in patients with end-stage dementia. A secondary objective was to investigate the cost of particular types of medication before and after a PCC.
  
  
  METHODS
  This was a retrospective study of 60 hospitalized patients with end-stage dementia at a large academic tertiary care hospital from January 1, 2010 to October 1, 2011, in order to investigate pharmacy costs before and after a PCC. In addition to demographics, we carried out a comparison of the average daily pharmacy cost and comparison of the proportion of subjects taking each medication type (cardiac, analgesics, antibiotics, antipsychotics and antiemetics) before and after a PCC.
  
  
  RESULTS
  There was a significant decrease in overall average daily pharmacy cost from before to after a PCC ($31.16 ± 24.71 vs. $20.83 ± 19.56; p < 0.003). There was also a significant difference in the proportion of subjects taking analgesics before and after PCC (55 vs. 73.3%; p < 0.009), with a significant average daily analgesic cost rise from pre- to post-PCC: $1.36 ± 5.07 (median = $0.05) versus. $2.35 ± 5.35 (median = $0.71), respectively, p < 0.011; average daily antiemetics cost showed a moderate increase from pre- to post-PCC: $0.08 ± 0.37 (median = $0) versus $0.23 ± 0.75 (median = $0), respectively, p < 0.047.
  
  
  CONCLUSIONS
  Our findings indicate that PCC is associated with overall decreased medication cost in hospitalized AD patients. Additionally, receiving a PCC was related to greater use of pain medications in hospitalized dementia patients. Our study corroborates the benefits of palliative care team intervention in managing elderly hospitalized dementia patients.
authors.affiliation: North Shore-Long Island Jewish Health System,Great Neck, New York.
authors.forename: Marissa
authors.initials: M
authors.lastname: Araw
authors.affiliation: North Shore-Long Island Jewish Health System,Great Neck, New York.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kozikowski
authors.affiliation: Feinstein Institute for Medical Research,Manhasset, New York.
authors.forename: Cristina
authors.initials: C
authors.lastname: Sison
authors.affiliation: North Shore-Long Island Jewish Health System,Great Neck, New York.
authors.forename: Tanveer
authors.initials: T
authors.lastname: Mir
authors.affiliation: North Shore-Long Island Jewish Health System,Great Neck, New York.
authors.forename: Maha
authors.initials: M
authors.lastname: Saad
authors.affiliation: North Shore-Long Island Jewish Health System,Great Neck, New York.
authors.forename: Lauren
authors.initials: L
authors.lastname: Corrado
authors.affiliation: North Shore-Long Island Jewish Health System,Great Neck, New York.
authors.forename: Renee
authors.initials: R
authors.lastname: Pekmezaris
authors.affiliation: North Shore-Long Island Jewish Health System,Great Neck, New York.
authors.forename: Gisele
authors.initials: G
authors.lastname: Wolf-Klein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000191:economics* / Q000628:therapy*; D005260:Female; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000191:economics*; D012017:Referral and Consultation / Q000191:economics*; D012189:Retrospective Studies
keywords: Dementia; End-of-life; Palliative Care Consult; Pharmacy Costs