May 6, 2020
In 2019, the United States spent over $630 billion on medical costs to treat 37 million older adults with life-limiting conditions (LLCs), such as Alzheimer’s disease, cancers and heart failure, said Joshua Thorpe, Ph.D., M.P.H, with the UNC Eshelman School of Pharmacy.
Average annual expenditures for older adults with LLCs are nearly three times higher than those with no LLCs ($19,000 vs. $6,500). Nearly 200,000 people may die of medication-related problems, with costs as high as $130 billion to the healthcare system, Thorpe said.
With the help of a VA-R01 equivalent $1.2 million grant, Thorpe wants to reduce medication-related problems in people nearing end-of-life by deprescribing unsafe or unnecessary medications. Thorpe, an associate professor in the School’s Division of Pharmaceutical Outcomes and Policy, said he believes that palliative care may provide an ideal venue for considering deprescribing of medications. Palliative care is an interdisciplinary approach that is focused on improving quality of life and relieving distressing symptoms for people with serious, life-limiting illness and their families.
Thorpe said a major goal of palliative care is to review patient/family treatment goals; including careful consideration of the value of current medications in light of changing goals of care.
“Palliative care should provide patients, families and providers an opportunity to clean up the meds,” Thorpe said. “But in a fragmented healthcare system, and with treating complex patients, there is often a big difference between ‘it should happen’, and ‘it does happen,’” Thorpe said.
Thorpe, also the director of Analytics & Research in the Department of Veterans Affairs National End-of-Life Care Center, said with the grant he aims to analyze over 3 million older adults with LLCs; 500,000 palliative care users compared to a control group of 250,000,000 similarly-matched non-users of palliative care. His study design will examine the change prescribing rates in 7 different measures of prescribing quality, before and after a documented palliative care encounter. Thorpe will then compare the rate of changes across groups. Finally, he will examine the effects of prescribing safety and quality on patient outcomes such as falls, fractures, nursing home admissions and mortality.
By examining the impact of palliative care on use of potentially unsafe medications, Thorpe hopes his project will inform policies and interventions designed to improve the quality of medication prescribing and over treatment of common chronic illnesses at end-of-life. By ensuring high-quality medication at end-of-life, he hopes to help patients remain in their communities with family and friends.
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