Are We Evolving Toward Greater and Earlier Use of Palliative Home Care Support? A Trend Analysis Using Population-Level Data From 2010 to 2015.

Date: 
07-05-2019

Authors: Arno Maetens, Luc Deliens, Lieve Van den Block, Kim Beernaert, Joachim Cohen

Source: 
Journal of pain and symptom management (2019)
Links: 
PubMed

Context

The need for increased use and earlier initiation of palliative home care has been advocated by several international organizations.

Objectives

To investigate time trends in the use and timing of initiating palliative home care support (PHCS).

Methods

We conducted an observational study using routinely collected population-level databases linked with health claims data for the entire population living at home that died of diseases indicative of palliative care needs in Belgium between 2010 and 2015 (n = 230,704). Trends and trends by cause of death and age were measured through changes over time in prevalence of use of PHCS. Rates were standardized for age, sex, and cause of death distribution in 2010. The median number of days before death when PHCS was initiated was calculated for each year.

Results

Uptake of PHCS increased from 31.7% to 34.9% between 2010 and 2015. Trends were similar in size for all groups, except for people who died of dementia (smallest increase with 1.9 percent point). The timing of initiating PHCS advanced from 41 to 46 days before death, with the smallest increase observed among people who died of dementia (+2.5 days). The proportion of people receiving PHCS only in the last week of life changed from 15.3% to 13.9%.

Conclusion

This population-level study found a slight trend toward more and earlier initiation of PHCS between 2010 and 2015. However, uptake of PHCS remained below estimated needs in the population and the proportion of people receiving PHCS in their very late life remained stable over time.

 
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