Impact of Medication-Related Problems in Hospitalized Patients Eligible for Palliative Care: A Prospective Cohort Study.
Abstract
Background
Hospitalized patients receiving palliative care frequently present multimorbidity and polypharmacy, increasing exposure to adverse drug events (ADEs). Evidence specific to this population, particularly in middle-income countries, remains scarce.
Methods
Prospective observational cohort study conducted from January to December 2024 at a regional referral hospital in southern Minas Gerais, Brazil. Adult inpatients with palliative care needs hospitalized for at least 48 hours were included and followed until discharge or death. ADEs were identified through electronic medical record review and semi-structured interviews, then classified by etiology, causality (WHO-UMC), severity, and preventability. Negative binomial regression was used to identify predictors of ADE number; secondary analyses assessed quality of life and potentially inappropriate medications (PIMs).
Results
Among 46 patients enrolled (63% male; mean age 70 years, SD 11.1), 47.8% died during hospitalization. The cumulative incidence of in-hospital ADEs was 73.9%. A total of 70 adverse drug reactions (ADRs) were identified, most frequently involving opioids (61.4%). ADRs predominated at admission and among patients who died; medication errors were more frequent at discharge. Severe events were more frequent among patients who died; medication errors were, by definition, classified as potentially preventable. Age (IRR 1.030; 95% CI 1.002-1.060; p=0.036), time since diagnosis (IRR 1.0004; p=0.004), and Palliative Prognostic Index (PPI) score (IRR 1.099; p=0.034) were significant predictors of ADE number. A higher PIM count was associated with worse quality of life (β=0.386; p=0.031).
Conclusions
Nearly three-quarters of hospitalized patients receiving palliative care experienced at least one ADE, and opioids accounted for the majority of identified ADRs. Structured pharmacovigilance, medication reconciliation, and systematic pharmacotherapy review are warranted to improve medication safety in this setting.