News in brief - March 14, 2011

Hospice use and end-of-life care costs rise

Advocates of greater use of hospice care for patients with terminal illnesses have argued that it would improve end-of-life care and avoid the high cost of hospitalization. Although use of hospice care doubled from 2000 to 2007 among Medicare patients with heart failure, the average cost of caring for them during the last six months of their lives rose 26% during that period, according to a study of nearly 230,000 patients published in the Feb. 14 Archives of Internal Medicine (archinte.ama-assn.org/cgi/content/abstract/171/3/196).

Nearly 20% of patients with heart failure used hospice in 2000, with the figure rising to 40% by 2007. However, 80% of these patients still were hospitalized in the last six months of their lives, and the number of days in intensive care units rose. Home health costs also increased. The average per-patient total cost to Medicare went from $28,766 in 2000 to $36,216 in 2007.

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Complicated prescription regimens confuse patients

Many older patients struggle to correctly take the multiple prescription drugs they use to treat various conditions, and vague label instructions are no help, said a study published in the Feb. 28 Archives of Internal Medicine. Researchers interviewed 464 patients between age 55 and 74 and asked how they would take seven prescriptions given varying instructions -- "every 12 hours" versus "twice daily," for example.

By properly following instructions, patients could have correctly taken all their pills at four times during a 24-hour period, but they typically organized the drugs into six dosing times. Less than 15% were able to optimally organize their schedules, the study said (archinte.ama-assn.org/cgi/content/abstract/171/4/300).

The authors argue that standardizing prescription labels by specifying four times to take medications (morning, noon, evening and bedtime) would reduce confusion, increase drug adherence and improve patient outcomes.

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