Abstract
BackgroundThere are no validated measuring tools to gauge the effectiveness of a Hospital Palliative Care Consultation Team (PCCT). One way would be to consider its effect on the consumption of opioids expressed in total amounts and different formulations administered. We perform this study to evaluate the impact of a hospital PCCT on the trends of opioid prescription in a University Hospital.MethodsA seven year retrospective study on opioid prescription was carried out in the Clínica Universidad de Navarra. The period includes three years before and three years after the PCCT was implemented. Prescription was analysed calculating yearly the Defined Daily Dose (DDD) adjusted to 1000 hospital stays (DDD/1000HS). Indicators considered were the proportion of patients treated using opioids compared to the total estimated in need of treatment (rate of effectiveness) and the proportion of patients potentially requiring opioids but not treated who were incorporated into the treatment group (rate of improvement).ResultsFrom 2001 to 2007, total opioid prescription was low in non-oncology Departments (range: 69–110 DDD/1000HS) while parenteral morphine and fentanyl did not register any changes. In the same period of time, total opioid prescription increased in the Oncology Department from 240 to 558 DDD/1000HS. The rate of effectiveness in the three years prior to the implantation of the consultation team was 64% and in the three following years rose to 87%. The rate of improvement prior to the palliative care consultation team was 43% and in the three following years was 64%. A change in opioid prescription was registered after the implementation of the PCCT resulting in an increase in the prescription of parenteral morphine and methadone and a decrease in transdermal fentanyl.ConclusionImplementation of a PCCT in a University Hospital is associated with a higher and more adequate use of opioids.
Highlights
There are no validated measuring tools to gauge the effectiveness of a Hospital Palliative Care Consultation Team (PCCT)
As the use of meperidine in Oncology was minimal (14–43 units per year), it was excluded from this analysis
The data from this study suggests that the implementation of PCCT in University Hospitals helps optimise the use of opioids in patients with cancer pain
Summary
There are no validated measuring tools to gauge the effectiveness of a Hospital Palliative Care Consultation Team (PCCT). There is evidence of the efficiency of interdisciplinary palliative care teams, based in hospitals and cancer centres [5]. A PCCT, usually does not have patient beds under its responsibility but rather it acts in an advisory role to other healthcare professionals and works with the aim of bringing palliative care principles into acute care hospitals [68]. The aim of improving palliative care in all hospital patients is achieved by providing direct care by the team and by offering advice to attending doctors [9], as well as by trying to influence the work of other care professionals and staff members [10,11].
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