Do community hospice programmes reduce hospitalisation rate in patients with advanced chronic obstructive pulmonary disease?

Abstract

Since Hinton first published his observations on the distress of patients dying on a medical ward in 1963, there has been increasing awareness of the palliative care needs in patients who have non malignant diseases. Patients with advanced chronic obstructive pulmonary disease (COPD) are known to have comparable symptom burden to lung cancer patients and are more likely receive invasive treatment at the end of life than patients with end stage lung cancer. They are also less likely to receive hospice services, and the benefit of such programmes in this key group of patients remain largely unknown, in particular what effect hospice programmes have on hospitalisation. (i) To examine any effect of community hospice programmes on hospitalisation in patients with advanced COPD. (ii) To identify any association between utilisation of specific hospice services with hospitalisation. (iii) To describe key peri-mortem outcomes. This was a retrospective study of consecutive patients with COPD admitted into community hospice programmes in the greater Wellington region, New Zealand between 1 October 2007 and 31 October 2013. A mean decrease of 2.375 (median decrease of 2; 95% confidence interval 1, 3) hospital admissions over a 12-month period was found after admission into hospice programme (P < 0.0005). Community hospice programmes may be associated with reduction in hospitalisation in patients with advanced COPD.