Abstract
BackgroundThe objective of the Balearic Islands Palliative Care (PC) Program is to improve the quality of PC through a shared model consisting of primary health care professionals, home-based PC teams, and PC units in hospitals. According to the World Health Organization (WHO), patients with advanced cancer and other terminal diseases benefit from early identification and proactive PC. We will evaluate the effectiveness of an intervention in which a PC leader is established in the primary health care center, and assess the effect of this intervention on the early identification of patients in need of PC, the efficient use of health care services, and direct health care costs.MethodsDesign: A two-arm cluster randomized clinical trial of 30 Primary Health Care Centers (PHCC) in Mallorca (Spain), in which each center was randomized to an intervention arm or a usual care arm. We expect that the number of patients identified as suitable for PC (including non-oncological PC) is at least 5% greater in the intervention arm.Sample size: A total of 4640 deceased patients. Outcomes will be assessed by a blinded external review of the electronic records.Interventions: General practitioners (GPs) and nurse leaders in PC for each PHCC will be appointed. These leaders will help promote PC training of colleagues, improve symptom management and psychological support of patients, and evaluate the complexity of individual cases so that these cases receive assistance from PC home-based teams.Measurements: Early identification (>90 days before death), evaluation of case complexity, level of case complexity (with referral to a home-based PC team), use and cost of hospital and primary care services, and quality of life during the last month of life (≥2 emergency room visits, ≥2 hospital admissions, ≥14 days of hospitalization).DiscusionPC leaders in primary care teams will improve the early identification of patients eligible for PC. This initiative could improve the quality of end-of-life care and utilization of hospital resources.Trial registrationISRCTN Registry identifier: ISRCTN92479122. Retrospectively registered on 28 February 2017.
Highlights
The objective of the Balearic Islands Palliative Care (PC) Program is to improve the quality of PC through a shared model consisting of primary health care professionals, home-based PC teams, and PC units in hospitals
– Early identification (90 days before death), by General practitioners (GPs) and nurses, of patients who are least 18 years-old and need PC based on electronic records
Identification of patients needing palliative care and classification according to case complexity Leaders in the early identification and assessment of case complexity of patients receiving referral to PC homebased services will train primary health care doctors
Summary
The objective of the Balearic Islands Palliative Care (PC) Program is to improve the quality of PC through a shared model consisting of primary health care professionals, home-based PC teams, and PC units in hospitals. The populations of European countries are getting older, and this is leading to major increases in the number of patients needing palliative care (PC) because of chronic incurable diseases or advanced stages of terminal diseases [1]. The organ failure model is characterized by a long period of functional limitations, which can last for about two to five years, in which acute and aggravating episodes occur. The third model of dementia/fragility in the elderly is characterized by a long period of functional decline, with a phase of very low physical and cognitive function that can last for several years. In this model, the decline is progressive and irreversible. There are difficulties in identifying the need for PC in these different situations due to differences in the natural courses of the illnesses and the rate of functional status decline
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
