Reducing hospital admissions in remote Australia through the establishment of a palliative and chronic disease respite facility

Abstract

BackgroundThere are limited respite services for palliative care patients and their families in the Northern Territory (NT). The high prevalence of complex chronic diseases, limited access to primary care services, and the poor living situations of many Aboriginal and Torres Strait Islander Australians result in high hospitalisation rates and pressure on tertiary health services. Palliative Care NT identified a need for a flexible, community based, culturally appropriate respite service in Alice Springs. It was of particular interest to assess the impact of the respite service on the extent to which hospital resources were accessed by this population of patients.MethodsRespite service use and hospital use data were collected over two time periods: the 12 months prior to the establishment of the service; and the first 10 months of the operation of the service. The financial implications of the facility were assessed in terms of the National Weighted Activity Unit (NWAU). Of primary interest in this study was the impact of the respite service on admissions to the Emergency Department (ED), to the Wards, and to the Intensive Care Unit (ICU). The amount of ventilator hours consumed was also of interest.ResultsOverall, there was a mean cost saving of $1882.50 per episode for hospital admissions with a reduction in: hospital admissions; mean length of stay; Intensive Care Unit (ICU) hours; and ventilator hours.ConclusionsThe establishment of the respite service has met an important and unmet need in Alice Springs: provision of respite where none has existed before. The service did assist with savings to the health department which could contribute to the cost of the facility over time. Two features of the respite facility that may have contributed to the savings generated were the enhanced coordination of care for patients with complex chronic diseases, as well as improved medication compliance and symptom management.

Access to Palliative Care for Cancer Patients Living in a Northern and Rural Environment in Ontario, Canada: The Effects of Geographic Region and Rurality on End-of-Life Care in a Population-Based Decedent Cancer Cohort

“…We expect that improving access to palliative care in this area could improve pain and symptom management and provide better patient and caregiver satisfaction and provide moderate relief on the use of potentially aggressive end-of-life care and potentially reduce hospital admissions and stays. 40–43…”

“…We expect that improving access to palliative care in this area could improve pain and symptom management and provide better patient and caregiver satisfaction and provide moderate relief on the use of potentially aggressive end-of-life care and potentially reduce hospital admissions and stays. [40][41][42][43] While southern rural residents did not demonstrate decreased likelihood of palliative care, rurality itself is a substantial barrier to care. Rural residents in general demonstrated higher use of ED and hospitalizations, as well as death in acute care hospital.…”

Why some patients who do not need hospitalization cannot leave: A case study of reviews in 6 Canadian hospitals

“…Providing respite has also been shown to be effective in preventing ED visits and hospital admissions. [20][21][22] Like Walker (2014) and Lavergne (2016), the reviewers suggested that primary care providers might have screened patients to identify support needs that would allow them to prevent crises that led to ED visits. The reviewers also saw opportunities for hospitals to play a role in assessing people who present in an ED for additional supports they need to live safely in their homes.…”

Bioethics and Palliative Care in Primary Health Care

“…Among other reasons for the lack of access to PC in PHC, the limited resources, the lack of support equipment, and the lack of home care services prepared to assist patients eligible for PC are worth mentioning [2]. This issue should also be discussed under the scope of the principle of justice in the allocation of health resources and services, so as to ensure to all not only equipment and drugs aimed at the control of physical symptoms but also non-pharmacological interventions focused on the psychosocial-spiritual aspects of these patients, seeking to reduce the suffering and existential anguish attached to the dying process [14,33].…”

“…Thus, the importance of training PHC professionals to nonspecialized PC measures is paramount. They must seek to develop skills in the management of incurable symptoms, communication with patients and their families, and identification and treatment of basic psychological and spiritual problems [1,33]. A systematic review [34] showed that participating in PC training programs reduces the stress of nurses and improves their communication, attitudes, knowledge, and confidence in caring for PC patients.…”