Abstract
BackgroundResearch indicating that people increasingly prefer to die at home suggests that palliative care is likely to play a more prominent role in the future of Canada's health care system. Unfortunately, at a time when research evidence should be informing policy and service delivery, little is known about health service utilization by Canadians at the end of life. One existing mechanism that can help address this gap is provincial administrative health data. The purpose of this study was to explore the potential of administrative health data to identify characteristics of palliative care users, patterns of formal service utilization and predictors of palliative care use.MethodsBivariate and multivariate analyses were used to examine data from the Capital Health Region, British Columbia Linked Health Databases for the period 1992/93 to 1998/99. The databases examined include continuing care, physician claims, hospital separations, and vital statistics. As the name implies, these databases can be linked at the individual level using unique identifiers so that health services utilization can be tracked across sectors.ResultsGeneral patterns of service use among palliative care patients suggest that general practitioner and medical specialist visits have decreased over time and the utilization of hospital beds has increased. Utilization of community-based services (i.e. home support and home nursing care) shows an overall pattern of decline. However, when compared to non-palliative care patients, palliative care patients spent fewer nights in hospital, used fewer hours of home support, and had a greater number of home nursing care visits.ConclusionsAdministrative health databases can provide valuable information for examining service utilization patterns over time. However, given that decisions surrounding the designation of palliative care include factors beyond the scope of administrative databases (such as quality of life, personal preferences, social support), these databases should only be seen as one source of information to inform service delivery and policy decision making.
Highlights
Research indicating that people increasingly prefer to die at home suggests that palliative care is likely to play a more prominent role in the future of Canada's health care system
Housed at the University of British Columbia (BC), this database contains all provincial administrative health data collected by the BC Ministry of Health including physician claims, hospital separations, long-term care data, pharmacare data and vital statistics
Palliative care patient and health service utilization characteristics The linked administrative database allowed for a description of patient characteristics including age, gender, and income
Summary
Research indicating that people increasingly prefer to die at home suggests that palliative care is likely to play a more prominent role in the future of Canada's health care system. Care at the end of life is likely to play a more prominent role, in the future of Canada's health care system [4,5,6] This expectation is based on the projected increase in numbers of older persons and the associated heightened risk of developing agerelated chronic diseases such as cancer and cardiopulmonary disease. Conjoint with this expectation, the focus of care is shifting from institutional to community care. As governments seek to contain health care costs and caregivers search for improved quality of life for those nearing the ends of their lives, effective palliative and end of life care will become a more prominent research and policy issue
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