Who finds the road to palliative home care support? A nationwide analysis on the use of supportive measures for palliative home care using linked administrative databases

Abstract

BackgroundMany countries developed supportive measures for palliative home care, such as financial incentives or multidisciplinary palliative home care teams. For policy makers, it is important to evaluate the use of these national palliative home care supportive measures on a population level.Methods and findingsUsing routinely-collected data on all deaths in Belgium in 2012 (n = 107,847) we measured the use of four statutory supportive measures, specifically intended for patients who have obtained the legal palliative status, and three non-statutory supportive measures. Factors associated with uptake were analysed using multivariable logistic regression. Of all deaths of adult home-dwelling persons in Belgium (n = 87,007), 17.9 percent used at least one statutory supportive measure and 51.5 percent used at least one non-statutory supportive measure. In those who died of an illness indicative of palliative care needs 33.1 percent used at least one statutory supportive measure and 62.2 percent used at least one non-statutory supportive measure. Younger people and persons dying from cancer were more likely to use a statutory policy measure. Older people and persons dying from COPD were most likely to use a non-statutory policy measure. Women, non-single people, and those living in less urbanised areas were most likely to use any supportive measure.ConclusionsStatutory supportive measures for palliative home care are underused, even in a subpopulation of persons with potential palliative care needs. Policy makers should stimulate an equitable uptake, and reducing the observed inequalities is an important focus for health care policy.

Exploring the inclusion of dental providers on interprofessional healthcare teams treating patients with chronic obstructive pulmonary disease: a rapid review

“…For COPD patients living with multimorbidities, the best care option is to change from disease-focused to patient-centred care, whereby providers look beyond the COPD diagnosis and instead see the patient as a whole to better understand the etiology of their comorbidities 55 . Since comorbidities are often associated with a COPD diagnosis, healthcare teams should also shift to a more palliative-focused structure through partnerships with doctors, palliative experts (mainly nurses), and administrative executives to optimise quality of life and mitigate chronic suffering as much as possible 58 .…”

Home Based Palliative Care: Known Benefits and Future Directions

“…Compared to usual care, the addition of HBPalC lowers costs and resource utilization across high-risk elderly [8], cancer and non-cancer [15], heart failure [16], and COPD populations [11]. Evidence that HBPalC adds value to usual care spans the globe, including Australia [17], Belgium [11,12] Canada [18 •, 19], England and Ireland [20], Italy [17] and the United States [9•, 14].…”

“…For example, Gasper and colleagues describe that within the heart failure population, for whom disease trajectory is complex, unpredictable, and burdensome, the lack of clear differentiation between palliative care and hospice, the lack of administrative support across the acute to home care environments, and difficulty navigating reimbursement lead to missed opportunities to link patients and HBPalC services [16]. Maetens and colleagues similarly found that, despite largely comparable policies and practices across three European countries with similar clinical contexts, differences between the services offered and the criteria for patient coverage still contribute to underutilization of HBPalC services [12].…”

Healthcare utilization at the end of life in people dying from amyotrophic lateral sclerosis: A retrospective cohort study using linked administrative data

“…Nevertheless, healthcare professionals are often trained to prolong and maintain life for as long as possible [6], conceivably resulting in inappropriate continuation of treatments or hospitalizations that are futile near the end of life and possibly threaten the quality of life of patients [8,9]. Literature has shown that palliative care is most often used by cancer patients, despite being also beneficial to patients with other, non-malignant life-threatening illnesses (such as ALS) [10,11].…”