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

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.