Polypharmacy in Palliative Care: Can it be Reduced?

NY Koh, WH Koo
Correspondence: N Y Koh, kohnienyue@yahoo.com.sg

ABSTRACT
Introduction Minimising polypharmacy is important. A study was done to see if this was achievable in patients under palliative care and compares the types of drugs used before and after referral.
Method Medication charts of 345 patients seen in June to August 2000 in hospital-based palliative consultation service, home care and hospice, were reviewed. The drugs used were recorded on two occasions--before referral and two weeks after or just before discharge from hospital or hospice, provided that death was not imminent.
Result The median number of drugs used was five, before and after referral. Analgesics and laxatives were frequently used in palliative care (60.3% and 60% respectively). The commonest analgesic was opiates (41.2% before and 47.8% after referral). Only the difference in laxative usage (50.4% prior to referral and 60% after) was statistically significant at p<0.01. 40.3% of the patients had an increase in the number of drugs after referral and 45.3% of them had addition of laxatives, compared to less than 30% for other drugs. A significantly higher proportion of patients (24.6% versus 18%) were on two or more drugs for constipation after referral.
Conclusion Reducing polypharmacy in palliative care is often difficult. There was higher awareness of bowel habits and treatment of constipation amongst those involved in palliative care. In addition to reviewing the use of some drugs, other measures such as patient education may be useful in minimising polypharmacy.

Keywords: Polypharmacy, palliative care, drugs, laxatives, analgesics
Singapore Med J 2002; 43(6): 279-283