Abstract
BackgroundThe goal of palliative care is to prevent and alleviate a suffering of incurable ill patients. A continuous intersectoral palliative care is important. The aim of this study is to analyse the continuity of palliative care, particularly the time gaps between hospital discharge and subsequent palliative care as well as the timing of the last palliative care before the patient’s death.MethodsThe analysis was based on claims data from a large statutory health insurance. Patients who received their first palliative care in 2015 were included. The course of palliative care was followed for 12 months. Time intervals between discharge from hospital and first subsequent palliative care as well as between last palliative care and death were analysed. The continuity in palliative care was defined as an interval of less than 14 days between palliative care. Data were analysed using descriptive statistics and Chi-Square.ResultsIn 2015, 4177 patients with first palliative care were identified in the catchment area of the statutory health insurance. After general inpatient palliative care, 415 patients were transferred to subsequent palliative care, of these 67.7% (n = 281) received subsequent care within 14 days. After a stay in a palliative care ward, 124 patients received subsequent palliative care, of these 75.0% (n = 93) within 14 days. Altogether, 147 discharges did not receive subsequent palliative care. During the 12-months follow-up period, 2866 (68.7%) patients died, of these 78.7% (n = 2256) received palliative care within the last 2 weeks of life. Of these, 1223 patients received general ambulatory palliative care, 631 patients received specialised ambulatory palliative care, 313 patients received their last palliative care at a hospital and 89 patients received it in a hospice.ConclusionsThe majority of the palliative care patients received continuous palliative care. However, there are some patients who did not receive continuous palliative care. After inpatient palliative care, each patient should receive a discharge management for a continuation of palliative care. Readmissions of patients after discharge from inpatients palliative care can be an indication for a lack of support in the ambulatory health care setting and for an insufficient discharge management. Palliative care training and possibilities for palliative care consultations by specialists should strengthen the GPs in palliative care.
Highlights
The goal of palliative care is to prevent and alleviate a suffering of incurable ill patients
General inpatient palliative care is provided by physicians and nurses without training in palliative care on general wards supervised by a physician specialised in palliative medicine
Of the palliative care patients, 59.3% (n = 2477) had oncological diagnoses. 68.6% (n = 2866) patients died during the 12-month observation period
Summary
The goal of palliative care is to prevent and alleviate a suffering of incurable ill patients. Patients in advanced stages of their disease, who cannot be cared for in their own homes, have the possibility to move into a hospice In these facilities, the patients receive specialised palliative care by trained nurses and ambulatory palliative care by GPs or from physicians of a specialised ambulatory palliative care team [7]. Continuous, uninterrupted and intersectoral palliative care with no gaps of more than 14 days is important. This is the only way to ensure adequate symptom management, prevent a patient’s suffering and establish a relationship of trust [7, 8]
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