Improving prescribing of medications at EOL in LTC homes during COVID-19

Project status

Ongoing

Contact

Peter Tanuseputro

Institution web page

http://www.ohri.ca/profile/ptanuseputro

Host institution

Bruyere Research Institute

Team members

Peter Tanuseputro, Amy Hsu, Sarina Isenberg, Aynharan Sinnarajah, Jessica Simon, Justin Presseau, Hsie Seow, Daniel Kobewka, Tara Gomes, Breffni Hannon, Vivian Ewa, James Downar, Jenny Lau, Stafford Dean, Hugh Boyd, Camille Munro, Chandra Vig, Patrick Quail, Michelle Grinman, Navjot Virk, Rachel Boissonneault, Denyse Lynch, Amit Arya, Markus Schafer, Aleksandra Grzeszczuk, Melissa Brouwers, Colleen Webber, Luke Turcotte, Michelle Howard, Colleen Maxwell.

Funding information (if funded)

This project was funded by the Canadian Institutes of Health Research.

Project Summary

Knowledge users have identified a need to improve palliative care in long-term care (LTC) homes in Ontario and Alberta, and investigators in these provinces have access to data to conduct rapid implementation research. Our 3 main objectives are: 1. Data measurement to detect variations in end-of-life medication prescribing (proxy to palliative care delivery) before and during COVID-19; 2. Mixed methods evaluation to understand the barriers/facilitators of end-of-life prescribing in LTC; and 3. Intervention to support homes in both provinces, focusing on those most challenged to provide end-of-life care during COVID-19. For the quantitative component, we will use data on LTC homes in Ontario and Alberta held at Institute for Clinical and Evaluative Sciences (ICES) and Alberta Health Services (AHS). For the qualitative component, we will reach out to LTC homes identified as being top/bottom prescribers and interview staff, healthcare providers, and resident caregivers at these homes to gain a deeper understanding of the quantitative findings.

Outputs / Expected Outputs

Given delays with data extraction in Alberta and qualitative recruitment challenges, we have extended our timeline of project completion to December 2022.

We plan to publish at least one paper for each of the project objectives:

A quantitative descriptive manuscript on the prescribing patterns of end-of-life medications for LTC residents pre-COVID, and examine how they have changed during the COVID-19 pandemic
A quantitative manuscript evaluating the additional impact of COVID-19 outbreak status on end-of-life prescribing in LTC
A quantitative manuscript exploring variations in prescribing during COVID-19 across LTC home characteristics, prescriber characteristics, and resident characteristics
A qualitative manuscript outlining insights into end-of-life prescribing and care in LTC pre-COVID
A qualitative manuscript informed by our quantitative findings outlining insights into end-of-life prescribing and care in the top and bottom prescribing homes during COVID-19

We also plan to communicate our findings to our partners at Ontario Palliative Care Network (OPCN) and collaborate to develop educational resources for LTC homes that may have more challenges with providing end-of-life care during COVID-19 and beyond.

Project website