Is to refer patients to an inpatient facility where dobutamine can be administered.įor now, both Hospice Atlanta and Hospice Caring Project remain undecided about the future of dobutamine and milrinone use in their own facilities.ĭespite the reservations of some, there are others who say dobutamine is appropriate in the hospice setting, including some who provide in-home care. To add to the patient’s difficulties, home care agencies in the area are unable to provide home infusion of dobutamine. If patients want to continue taking dobutamine, they cannot be admitted. Potential patients of Hospice Caring Project who are on dobutamine were also diverted, says Cobb. Instead, patients are admitted to their sister home care agency’s palliative care program, where the cost of the drug is reimbursable. But once funding ran out, hospice-eligible patients on dobutamine or milrinone could not be admitted to hospice.
"We found that it wasn’t life-prolonging, but we couldn’t afford it."įor a time, Hospice Atlanta was able to experiment with in-home use of dobutamine and milrinone, with the cost of the drugs covered by Emory.
"We had always thought was an aggressive therapy, but after Emory talked to us about how it can be used in palliative care and that it was helping people feel more comfortable, we agreed," says Pamela Melbourne, RN, MN, director of clinical services for Hospice Atlanta. Hospice Atlanta had been receiving overtures from Atlanta’s Emory Clinic cardiologists regarding the use of dobutamine and milrinone, but the hospice had resisted because officials there believed that the drugs were an aggressive therapy that did not have a place in hospice care. "At home, it would place a lot of pressure on the caregiver and hospice staff." "Dobutamine needs constant monitoring," says Salima Cobb, RN, BSN, community liaison for Hospice Caring Project. Recently, the hospice has received requests from referring cardiologists to continue patients on dobutamine as the patients are moved from hospital care to hospice care.
Like many hospices around the country, officials at Hospice Caring Project in Aptos, CA, have been pondering these very same questions. Lastly, some question whether the use of these drugs fosters the principles of palliative care, which stress not only symptom management but also spiritual and emotional care. There also is concern over how appropriate it is to use these drugs in the home, given the amount of patient monitoring they require. Without the ability to seek reimbursement for the drug separate from Medicare’s per diem payment, a hospice could lose thousands of dollars per patient. For one thing, dobutamine, which is administered intravenously, is prohibitively expensive. Unfortunately, it is not a cure for patients suffering from heart failure, leaving many eligible for hospice care after the heart has deteriorated beyond repair and a heart transplant is not an option.īut there is considerable debate over whether hospices can accept patients on dobutamine, which is marketed as Dobutrex, or milrinone, which is marketed under the name Primacor. Cardiologists have used it and milrinone to help a weakened heart pump more efficiently. Dobutamine and milrinone acceptable for in-home hospice care But high cost may prevent hospices from using themĭobutamine has long been used to help patients suffering from heart failure.
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