Poraba zdravil v zadnjih šestih dneh življenja in njihova finančna ocena Use of medicines in the last six days of life and their financial evaluation

Povzetek

Paliativna oskrba prinaša neozdravljivo bolnim mnoge prednosti. V zadnjih dnevih pred smrtjo se lahko pojavi 5 najpogostejših simptomov (bolečina, slabost in bruhanje, nemir in zmedenost, dispneja, povečan izloček dihalnih poti), ki jih blažimo z vnaprej predpisanimi zdravili. Namen retrospektivne raziskave je bil ugotoviti razlike v porabi zdravil v zadnjih 6 dnevih med bolniki v paliativni oskrbi, ki jih je vodil tim za paliativno oskrbo, in bolniki, ki so bili vodeni na drugih oddelkih Onkološkega inštituta in paliativni tim v njihovo oskrbo ni bil vključen (kontrolna skupina). V vsaki skupini je bilo po 25 bolnikov; skupini sta bili primerljivi glede na mesto primarnega tumorja in starost bolnikov. Ugotovili smo, da je večina bolnikov v obeh skupinah prejemala močne opioide, druga zdravila za blaženje simptomov (haloperidol, midazolam, deksametazon, butilskopolamin, metoklopramid) pa je prejelo več bolnikov v paliativni oskrbi. Bolniki v paliativni oskrbi so v povprečju prejeli 10 različnih zdravilnih učinkovin, v kontrolni skupini pa 14. Stroški za zdravila so bili 2,7-krat manjši v skupini bolnikov, vključenih v paliativno oskrbo, in so znašali 15 € na bolnika na dan, medtem ko so za bolnika v kontrolni skupini znašali 42 € na dan. Razlika v stroških je bila predvsem posledica nepotrebnega predpisovanja nizkomolekularnih heparinov, sistemskih antibiotikov in antimikotikov ter parenteralne prehrane.

Abstract (Eng)

Palliative care offers numerous benefits to the incurably ill patients. In the last days before death, patients may experience 5 most frequent symptoms (pain, nausea and vomiting, restlessness and confusion, dyspnea, increased secretion from the respiratory tract), which are alleviated by medicines prescribed in advance. The purpose of the retrospective research was to determine the differences in the use of medicines in the last 6 days of life among patients in palliative care who were managed by the palliative care team and patients managed at other departments of the Institute of Oncology without the help of the palliative care team (control group). Each group consisted of 25 patients; the groups were comparable with regard to the primary tumour site and age of the patients. We have established that the majority of patients in both groups received strong opioids, while more patients in palliative care also received other medicines for the relief of symptoms (haloperidol, midazolam, dexamethasone, butylscopolamine, metoclopramide). On average, the patients in palliative care were given 10 different active substances, and the control group received 14. The cost of medicines in the palliative care group of patients was 15 € per patient per day, which was 2.7 times lower than in the control group, where the cost of medicines amounted to 42 € per patient per day. The difference in the costs was primarily a result of the unnecessary prescribing of low-molecular heparins, systemic antibiotics and antimycotics, and parenteral nutrition.