Physician Billing in Long-Term Care Homes and the Association With the Prescribing of End-of-Life Symptom Management Medications: A Population-Based Retrospective Cohort Study

Abstract

Objectives

Medications are often needed to manage distressing end-of-life symptoms (eg, pain, agitation, dyspnea). We evaluated whether physician billing in long-term care (LTC) was associated with LTC residents’ receipt of an end-of-life symptom management medication prescription.

Design

Retrospective cohort study using administrative health data.

Setting and Participants

All LTC decedents in Ontario's 626 publicly funded LTC homes who died between January 1, 2017, and March 17, 2020, were matched to a physician most responsible for their care (MRP) in LTC.

Methods

We measured the proportion of an MRP's billings that occurred in LTC. The prescribing of 1+ end-of-life symptom management medications was captured in LTC residents' last 2 weeks of life using prescription claims data.

Results

The study included 54,445 LTC decedents and 1855 MRPs. MRPs had a median of 9% of their total billings in LTC (interquartile range 3% to 23%). Two-thirds of LTC decedents (36,682, 67.4%) had at least one end-of-life medication prescription, the most common of which was opioids (prescribed to 65.4% of decedents). There was no difference in the odds of a decedent having a prescription for an end-of-life medication based on their MRP's proportion of billings in LTC (adjusted odds ratio for a 10% increase in an MRPs' billings in LTC 1.01, 95% CI, 0.99–1.02).

Conclusions and Implications

Across Ontario's LTC homes, there are large variations in prescribing rates for end-of-life symptom management medications; however, a physician's proportion of billings in LTC was not associated with a greater likelihood of prescribing.