Population-based trends in referral of the elderly to a comprehensive palliative care programme

Johnston, Grace; Lawson, Beverley; Dewar, Ron; Cummings, Ina

doi:10.1191/0269216302pm550xx

Cited by 31 publications

(30 citation statements)

References 3 publications

(1 reference statement)

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“…This is particularly evident among the very elderly, who in this study, were 60% less likely to be registered than those <65 years. In past studies, some of this disparity was suggested to be due to LTC residency where palliative needs may potentially be met 3,8 or associated with a greater comorbidity burden and possible alternative treatment options. 33 However, these variables have been controlled for in this study.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6][7] In Canada, our early research on end-of-life care in Nova Scotia (NS) focusing on palliative care program (PCP) registration among patients in the urban area of Halifax, found that the percent of individuals who died of cancer having made at least one contact with this PCP rose from 39% in 1992 to 62% in 1997, an increase that may have been due, in part, to the expansion of the program. 8 The Halifax-based PCP includes an inpatient palliative care unit, hospital and outpatient interdisciplinary team-based consultation and ongoing care, and home-based palliative team care. However, despite this increase in access, this early research also indicated the elderly were the least likely to be cared for by the PCP.…”

mentioning

confidence: 99%

“…For cancer patients 85 years and older it rose from 22% in 1992 to only 38% in 1997. 8 Even though inequalities in PCP access by age have been shown to exist in Canada and elsewhere, few studies provide greater insight by simultaneously adjusting for multiple demographic, health service, and socio-cultural indicators. Issues of need, health service availability, health service utilization, and factors relating to the social, economic, or cultural effect of an individual's place of residence or "neighborhood" can all potentially affect the estimates associated with PCP access and age.…”

mentioning

confidence: 99%

See 2 more Smart Citations

A Population-based Study of Age Inequalities in Access to Palliative Care Among Cancer Patients

Lawson¹,

Johnston²,

Grunfeld³

2008

Medical Care

101

102

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

A Population-based Study of Age Inequalities in Access to Palliative Care Among Cancer Patients

Lawson¹,

Johnston²,

Grunfeld³

2008

Medical Care

101

102

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“…Research is lacking on the relationship between nursing home residence and access to PRT, although there is evidence of low enrolment rates of nursing home residents in comprehensive palliative care programs. 26,[32][33][34] Our findings highlight the importance of ensuring that nursing home residents have access to comprehensive palliative services, including PRT where appropriate. Prior medical oncology consultation was associated with increased PRT rates.…”

Section: Health Service Variablesmentioning

confidence: 99%

Variation in the use of palliative radiotherapy at end of life: Examining demographic, clinical, health service, and geographic factors in a population-based study

et al. 2010

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Palliative radiotherapy (PRT) can improve quality of life for people dying of cancer. Variation in the delivery of PRT by factors unrelated to need may indicate that not all patients who may benefit from PRT receive it. In this study, 13,494 adults who died of cancer between 2000 and 2005 in Nova Scotia, Canada, were linked to radiotherapy records. Multivariate logistic regression was used to examine the relationships among demographic, clinical, service, and geographic variables, and PRT consultation and treatment. Among the decedents, 4188 (31.0%) received PRT consultation and 3032 (22.3%) treatment. PRT declined with increased travel time and community deprivation. Females, older persons, and nursing home residents also had lower PRT rates. Variations were observed by cancer site and previous oncology care. Variations in PRT use should be discussed with referring physicians, and improved means of access to PRT considered. Benchmarks for optimal rates of PRT are needed.

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“…15 Over time the program has expanded to provide service delivery to all sectors of the community and in 1997 saw approximately 62% of all adults who died due to cancer in the Halifax Regional Municipality. 16 A multidisciplinary team follows patients across care settings, including the home, an outpatient clinic, an inpatient palliative care unit, and throughout the QEII HSC hospital sites. Today the PCS is expected to meet the needs of terminal adult patients throughout the Capital District Health Authority (CDHA).…”

Section: Introductionmentioning

confidence: 99%

Can the Introduction of an Integrated Service Model to an Existing Comprehensive Palliative Care Service Impact Emergency Department Visits among Enrolled Patients?

Lawson

McIntyre²,

Field³

et al. 2009

Journal of Palliative Medicine

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Purpose-Fewer emergency department (ED) visits may be a potential indicator of quality of care during the end of life. Receipt of palliative care, such as that offered by the adult Palliative Care Service (PCS) in Halifax, Nova Scotia, is associated with reduced ED visits. In June 2004, an integrated service model was introduced into the Halifax PCS with the objective of improving outcomes and enhancing care provider coordination and communication. The purpose of this study was to explore temporal trends in ED visits among PCS patients before and after integrated service model implementation.Methods-PCS and ED visit data were utilized in this secondary data analysis. Subjects included all adult patients enrolled in the Halifax PCS between January 1, 1999 and December 31, 2005, who had died during this period (N = 3221). Temporal trends in ED utilization were evaluated dichotomously as preintegration or postintegration of the new service model and across 6-month time blocks. Adjustments for patient characteristics were performed using multivariate logistic regression.Results-Fewer patients (29%) made at least one ED visit postintegration compared to the preintegration time period (36%, p < 0.001). Following adjustments, PCS patients enrolled postintegration were 20% less likely to have made at least one ED visit than those enrolled preintegration (adjusted OR 0.8; 95% confidence interval 0.6-1.0).Conclusion-There is some evidence to suggest the introduction of the integrated service model has resulted in a decline in ED visits among PCS patients. Further research is needed to evaluate whether the observed reduction persists.

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Population-based trends in referral of the elderly to a comprehensive palliative care programme

Cited by 31 publications

References 3 publications

A Population-based Study of Age Inequalities in Access to Palliative Care Among Cancer Patients

A Population-based Study of Age Inequalities in Access to Palliative Care Among Cancer Patients

Variation in the use of palliative radiotherapy at end of life: Examining demographic, clinical, health service, and geographic factors in a population-based study

Can the Introduction of an Integrated Service Model to an Existing Comprehensive Palliative Care Service Impact Emergency Department Visits among Enrolled Patients?

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