Effects of Home Morphine Subcutaneous Infusion to Palliative Care Patients Using an Opioids Box: Case Study in Muang District, Udonthani

Abstract

This prospective descriptive study had objective to study the clinical outcomes and costs of palliative care patients receiving subcutaneous morphine at home using Opioids boxes before and after home visits during August - September 2023 in 49 palliative care patients living in Mueang district, Udonthani province. Tools were Edmonton Symptom Assessment System Thai version and drug related problems(DRPs) form. The descriptive statistics used to analyse data were percentage, mean, standard deviation and paired T-test.

Results: Most patients were over 60 years old (61.12%). The top 3 diseases were colon cancer (16.33%), lung cancer (12.25%) and sepsis (12.25%). This study found drug related problems in 12 cases (24.49%) including non-compliance (33.33%) adverse drug reaction (25.00%) dosage too low (16.67%) Drug-Herb interaction (16.67%) and improper drug use selection (8.33%). There were ineffective results from treatment (66.67%) and adverse reactions from drug use (33.33%). The problems solving by giving medication advice, verify morphine administration, medication reconciliation and use knowledge media. Clinical results before and 72 hours after home visit had significantly decrease including pain, fatigue, nausea, anxiety, drowsiness, loss of appetite, physical and mental well being and restless (p-value < 0.001 all), while depressive symptoms had no significantly (p-value = 0.139). Most patients save more than 240 minutes of travel time (48.98%), save costs more than 300 baht per visit (55.10%).

Conclusions: Home visits to palliative care patients receiving subcutaneous morphine using an Opioids box resulted in significant clinical outcomes and reduced travel time and costs for patients and family.