Abstract
Background/aims: The final six months of a person’s life are the most resource intensive in terms of health system usage, with 80% of this expenditure occurring in hospital. Whilst there are considerable data examining hospital service provision, there is little known regarding associated usage of primary care services in the Australian setting. Objective: This project aims to explore how primary care involvement affects health service usage and quality of life for cancer patients in the last year of life.
Methods: Retrospective cohort study using linked routine care and administrative data from two hospital networks, primary care and national death certificate. Patients were included who were diagnosed with cancer and died from a cause related to cancer between January 2007 - 2017.
Results: A total of 758 patients were included who had linked records from all sources and died from a cancer related cause. General practi- tioners were closely involved in care during this period, with 88% of patients visiting their GP during the last six-months (mean 9.1 consulta- tions). These visits became more frequent in the last stages of life, with 59% of patients consulting their GP in the last month of life, and 60% the month prior. This care was largely appropriate, with 45% of patients pre- scribed pain medication, and few requests for imaging (3%) and pathol- ogy (9%) in the last month.
Two cohorts were defined on their patterns of GP usage: cohort 1 (n=387) having regular consultations, and cohort 2 (n=371) not having this regularity. The first cohort were older (73.7 vs 67.3yrs, p<0.001) and had more comorbidities (mean 1.1 vs 0.77, p=0.002). Secondary health care usage was alike through both cohorts: admissions in the last three (median 1 [1-2] vs 1[0-2]) and one (med 1[0-1] vs 1[0-1]) month. Rates of indicators of quality end of life care were similar, including palliative care referral (61% vs 59%), and chemotherapy (5% vs 3%), surgery (7% vs 6%) and emergency department use (45% vs 43%) in the last month. Patients in the regular care cohort had longer admissions at 3 months (med 5. [2.8-11.0] vs 4.5[2.0-9.1] bed days per admission, p=0.014), but this dif- ference was not significant in the last month of life (med 5.7[2.0-11.0] vs 4.7[2.0-10.0], p=0.312).
Conclusions: The results demonstrate that these two cohorts have simi- lar patterns of health care usage and indicators of quality end-of-life care. This is despite the first cohort being older and increased comorbid conditions, and thus may have been expected to have more frequent and extended admissions.
Methods: Retrospective cohort study using linked routine care and administrative data from two hospital networks, primary care and national death certificate. Patients were included who were diagnosed with cancer and died from a cause related to cancer between January 2007 - 2017.
Results: A total of 758 patients were included who had linked records from all sources and died from a cancer related cause. General practi- tioners were closely involved in care during this period, with 88% of patients visiting their GP during the last six-months (mean 9.1 consulta- tions). These visits became more frequent in the last stages of life, with 59% of patients consulting their GP in the last month of life, and 60% the month prior. This care was largely appropriate, with 45% of patients pre- scribed pain medication, and few requests for imaging (3%) and pathol- ogy (9%) in the last month.
Two cohorts were defined on their patterns of GP usage: cohort 1 (n=387) having regular consultations, and cohort 2 (n=371) not having this regularity. The first cohort were older (73.7 vs 67.3yrs, p<0.001) and had more comorbidities (mean 1.1 vs 0.77, p=0.002). Secondary health care usage was alike through both cohorts: admissions in the last three (median 1 [1-2] vs 1[0-2]) and one (med 1[0-1] vs 1[0-1]) month. Rates of indicators of quality end of life care were similar, including palliative care referral (61% vs 59%), and chemotherapy (5% vs 3%), surgery (7% vs 6%) and emergency department use (45% vs 43%) in the last month. Patients in the regular care cohort had longer admissions at 3 months (med 5. [2.8-11.0] vs 4.5[2.0-9.1] bed days per admission, p=0.014), but this dif- ference was not significant in the last month of life (med 5.7[2.0-11.0] vs 4.7[2.0-10.0], p=0.312).
Conclusions: The results demonstrate that these two cohorts have simi- lar patterns of health care usage and indicators of quality end-of-life care. This is despite the first cohort being older and increased comorbid conditions, and thus may have been expected to have more frequent and extended admissions.
| Original language | English |
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| Pages | 27 |
| Number of pages | 1 |
| Publication status | Published - 19 May 2022 |
| Externally published | Yes |
| Event | European Association of Palliative Care World Research Congress - Duration: 18 May 2022 → 20 May 2022 |
Conference
| Conference | European Association of Palliative Care World Research Congress |
|---|---|
| Abbreviated title | EAPC 2022 |
| Period | 18/05/22 → 20/05/22 |