Abstract
The aim of this systematic review was to determine the impact that specialist community palliative care teams (SCPCT) have on acute hospital admission rates in adult palliative care (PC) patients who require End of Life Care (EOLC). Using systematic review methodology, eight studies were obtained from thorough searching of CINAHL, Medline and Embase databases. The review question was formulated using the PICO mnemonic - Population, Intervention, Comparison and Outcome. PRISMA guidelines were used to conduct the review and record the database searches. Data were extracted using a pre-designed extraction tool and all included studies were quality appraised using the checklist. The results are presented as a narrative review. For the purposes of this review SCPCT is a minimum of one specialist doctor and one specialist nurse. The eight selected studies reported that when SCPCT's cared for patients requiring EOLC there was a reduction in the admission rates to acute hospital settings in comparison to those who received standard care only. Some studies showed this reduction to be as high as 33% and 34% in the last year of life. With regards to secondary outcomes the studies that evaluated the impact of SCPCT's on emergency department usage and hospital death rates all found that SCPCT's had a positive influence in both areas. With regards to emergency department usage, one study reported the most significant reduction of 51% for patients who had SCPCT compared with those who had not. With regards to hospital death rates, the most significant results found that 39% of patients receiving SCPCT died in hospital compared to 74.8% who did not receive SCPCT. This review demonstrates that SCPCT's have a positive impact in reducing acute hospital admissions in adult patients requiring EOLC, however, these results may not be conclusive. Palliative care is a complex intervention with a very diverse population. It is vital therefore that further research and investigation, accounting for the confounding factors that may affect the accuracy of the results, is undertaken.
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