Is there an unmet medical need for palliative care services in Germany? Incidence, prevalence, and 1-year all-cause mortality of palliative care sensitive conditions: real-world evidence based on German claims data

H Gothe,C Ohlmeier,N Schmedt,J Walker,C Brinkmann

doi:10.1007/s10389-020-01319-7

Abstract

AimTo characterize palliative care patients, to estimate the incidence, prevalence, and 1-year all-cause mortality in patients in Germany who received palliative care treatment.Subject and methodsThe study analyzed the InGef Research Database, which covers 4 million people insured in German statutory health insurance companies. Specific outpatient and inpatient reimbursement codes were used to capture cases with palliative conditions. The prevalence was ascertained for the year 2015. The incidence was calculated for patients without documented palliative care services in the year before the observation period. The Kaplan–Meier method was used to analyze the 1-year all-cause mortality.ResultsThe incidence rate of palliative conditions was 41.3 and 34.9 per 10,000 persons in women and men, respectively. The prevalence per 10,000 persons was 61.3 in women and 51.1 in men. The 1-year all-cause mortality among patients receiving their first palliative care treatment was 67.5%. Mortality was lower in patients receiving general outpatient palliative care treatment (AAPV; 60.8%) compared to patients receiving specialized outpatient palliative care treatment (SAPV; 86.1%) or inpatient palliative care treatment (90.6%). Within the first 30 days, mortality was particularly high (~43.0%).ConclusionsIn Germany, more than 400,000 patients per year receive palliative care treatment, which is lower compared to estimates of the number of persons with a potential need for palliative care. This gap was observed particularly in younger to middle-aged individuals. The findings indicate a demand for methodologically sound studies to investigate the public health burden and to quantify the unmet need for palliative care in Germany.

Highlights

With the epidemiological and demographic transition affecting modern societies, the need for medical care is changing
The findings indicate a demand for methodologically sound studies to investigate the public health burden and to quantify the unmet need for palliative care in Germany
The majority of the patients received AAPV as the initial palliative care treatment (76.1%), whereas the inpatient complex palliative treatment and the specialized outpatient palliative care treatment (SAPV) were rarely observed as an initial palliative care treatment (14.6% and 9.3% respectively)

Summary

Introduction

With the epidemiological and demographic transition affecting modern societies, the need for medical care is changing. Complex end-of-life care becomes more relevant with regard to multiple comorbidities and possible benefits at several stages of a condition (WHO 2011). In this context, palliative care is understood as care for patients with lifethreatening diseases and their families, to increase their quality of life. In Germany, an increasing demand of palliative. J Public Health (Berl.): From Theory to Practice care is to be expected due to the demographic transition (Simon et al 2012), as well as a realization of the patients’ preference with regard to the place of death. While studies show that most patients want to die at home (Escobar Pinzon et al 2013; Gomes et al 2012), only one third does so (Escobar Pinzon et al 2013; Sauer et al 2015)

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