Generalist primary and palliative care is associated with few hospitalisations in the last month of life.

Abstract

Background Hospitalisations in the last phase of life may be related to poor quality of palliative care at home. In the Netherlands, that has a generalist palliative care model, palliative care at home can be given by generalist and palliative care consultants. Aim To study the association between provision of primary and palliative care at home and hospitalisations in the last phase of life in the Netherlands. Methods We conducted a cross sectional survey among Dutch general practitioners (GPs) on their most recent patient that died non-sudden. Of 1601 eligible GPs, 598 responded (37%). Questions were asked on (timing of) hospitalisation and on elements of primary care,generalist palliative care and consultation of specialised palliative care. The relation between these elements and hospitalisation were tested controlling for patient characteristics. Results Two primary care elements were related to both not being hospitalised in the last week of life and not being hospitalised in the last month of life: having more GP visits two to three months before death (OR=2.64 and OR=2.37) and information transfer to out-of-hours GP services more than one week before death (OR=2.02 and OR=1.64). The two palliative care elements studied were only associated to not being hospitalised in the last month of life: recognising that death was near earlier (OR=1.75) and having palliation as the main treatment aim (OR=2.34). Consultation of a specialised palliative care professional in the last three months of life, was not found to be associated with not being hospitalised. Discussion Our results show that generalists, especially GPs, can play an important role in providing palliative care at the end of life, when looking at hospitalisations as indicator of quality. This suggests that a generalist palliative care model is feasible