Equity of access to adult hospice inpatient care within north-west England

Abstract

There is a growing debate about the question of equity of access to hospice and palliative care services. Even countries with relatively well developed palliative care systems are considered to have problems of access and inequity of provision. Despite these concerns, we still lack a relevant evidence base to serve as a guide to action. We present an analysis of access to adult hospice inpatient provision in the north-west region of England that employs Geographical Information Systems (GIS). Measures of the possible demand for, and supply of, hospice inpatient services are used to determine the potential accessibility of cancer patients, assessed at the level of small areas (electoral wards). Further, the use of deprivation scores permits an analysis of the equity of access to adult inpatient hospice care, leading to the identification of areas where additional service provision may be warranted. Our research is subject to a number of caveats--it is limited to inpatient hospice provision and does not include other kinds of inpatient and community-based palliative care services. Likewise, we recognise that not everyone with cancer will require palliative care and also that palliative care needs exist among those with nonmalignant conditions. Nevertheless, our methodology is one that can also be applied more generally.

Dying in the Margins: Understanding Palliative Care and Socioeconomic Deprivation in the Developed World

“…Further analysis and understanding of the experience of the dying poor and their families is required, with a focused commitment to both identify and evaluate interventions aimed at modifying and eliminating disparity. Hospice enrolment reduced emergency room visits for low SE groups (Bergman et Longer drive times to palliative care services for patients in SE deprived areas (Wood et al 2004) …”

“…The ad-hoc nature in which palliative care services have developed worldwide has supported disparities in access based on geographical location [41,42] A meta-analysis by Higginson and Constatini [36] found that the distribution of palliative care services in Europe was inequitable and that services were not necessarily located in areas based on greatest need . Poor Indigenous groups in rural and remote areas in Australia, held very strong cultural and spiritual preferences for home deaths, but were least likely to achieve this aim, due to a lack of local services [25].…”

“…Poor Indigenous groups in rural and remote areas in Australia, held very strong cultural and spiritual preferences for home deaths, but were least likely to achieve this aim, due to a lack of local services [25]. A study by Wood et al [41] established that longer drive times to services and increased demand for those services were more likely in areas with high levels of deprivation in North-West England. Geographical access was a more likely determinant of disparity for low SE groups compared to others.…”

“…The current fragmentation of medical care, resulting in multiple outpatient visits for patients, was likely to further exacerbate the costs of transportation and thus geographical access for this group. Costs were often paired in the literature with geographical access issues [17,41,44]. Costs of end of life care increased where distances to service locations were greatest [17].…”

A study of the effects of innovative and efficient practices on the performance of hospice care organizations

“…Only a relatively small number of empirical studies have been conducted on administrativerelated issues. Since the palliative care movement began in England, several studies have examined funding and access issues in the United Kingdom (cf., Matthew, Cowley, Bliss, & Thistlewood, 2003;Sims, 1995;Wood, Clark, & Gatrell, 2004). A couple of studies have examined similar funding and utilization issues in the United States (cf., Han et al, 2006;Huskamp, Buntin, Wang, & Newhouse, 2001).…”