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Gesell D, Hodiamont F, Bausewein C, Koller D. Accessibility to specialist palliative care services in Germany: a geographical network analysis. BMC Health Serv Res 2023; 23:786. [PMID: 37488579 PMCID: PMC10364400 DOI: 10.1186/s12913-023-09751-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/26/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The need for palliative care will increase over the next years because of the rise in deaths from chronic illness and demographic changes. The provision of specialist palliative care (SPC) in Germany (palliative care units (PCU), specialist palliative home care (SPHC) teams and palliative care advisory (PCA) teams) has been expanded in recent years. Despite the increasing availability, there is still insufficient coverage with long travel times. The aim was to describe the spatial distribution of SPC services in Germany, to calculate the potential accessibility of facilities and to assess potential spatial under-provision. METHODS Retrospective cross-sectional study with regional analysis of SPC services in Germany. Addresses of SPC services registered online were geocoded, accessibility and network analyses were conducted, and proportion of the population living up to 60 minutes driving time were calculated. RESULTS A total of 673 facilities were included. Their distribution is heterogeneous with every fourth of the 401 districts (110/401; 27.4%) lacking a SPC service. In half of the area of Germany the existing PCU and SPHC teams are within reach of 30 minutes, with nearly 90% of the population living there. Hospitals providing PCA teams can be reached within 30 minutes in 17% of the total area with provision for 43% of the population. CONCLUSIONS A high coverage of SPHC teams and PCU indicates a good spatial distribution in Germany but no complete adequate provision of SPC services, especially for PCA teams. There is a persistent need for further implementation of hospital PCA teams.
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Affiliation(s)
- Daniela Gesell
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany.
| | - Farina Hodiamont
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Daniela Koller
- Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
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Chukwusa E, Font-Gilabert P, Manthorpe J, Healey A. The association between social care expenditure and multiple-long term conditions: A population-based area-level analysis. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565231208994. [PMID: 37900010 PMCID: PMC10612455 DOI: 10.1177/26335565231208994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/29/2023] [Indexed: 10/31/2023]
Abstract
Background Multiple long-term health conditions (MLTCs) are common and increasing among older people, yet there is limited understanding of their prevalence and association with social care expenditure. Aim To estimate the prevalence of MTLCs and association with English social care expenditure. Methods Our study population included those aged ≥ 65 who died in England in the year 2018 with any of the following long-term conditions recorded on their death certificate: diabetes; cardiovascular diseases (CVDs) including hypertension; dementia; stroke; respiratory; and chronic kidney diseases (CKDs). Prevalence was based on the proportion of death reported for older people with MTLCs (≥ 2) in each of the 152 English Local Authorities (LAs). Ordinary least square regression (OLS) was used to assess the relationship between prevalence of MTLCs and adult social care expenditure, adjusting for LA characteristics. Results Of the 409551 deaths reported, 19.9% (n = 81395) had ≥ 2 MTLCs, of which the combination of CVDs-diabetes was the most prevalent. Hospitals were the leading place of death for those with MTLCs. Results from the OLS regression model showed that an increased prevalence of MLTCs is associated with higher LA social care expenditure. A percentage point increase in prevalence of MLTCs is associated with an increase of about £8.13 in per capita LA social care expenditure. Conclusion Our findings suggest that the increased prevalence of MTLCs is associated with increased LA social care expenditure. It is important for future studies to further explore the mechanisms or link between LA social care expenditure and the prevalence of MTLCs.
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Affiliation(s)
- Emeka Chukwusa
- Cicely Saunders Institute, King’s College London, London, UK
| | - Paulino Font-Gilabert
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, The David Goldberg Centre, King’s College London, London, UK
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care Workforce, King’s College London, London, UK
| | - Andrew Healey
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, The David Goldberg Centre, King’s College London, London, UK
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Davies JM, Sleeman KE, Ramsenthaler C, Prentice W, Maddocks M, Murtagh FE. The association between socioeconomic position and the symptoms and concerns of hospital inpatients seen by specialist palliative care: Analysis of routinely collected patient data. Palliat Med 2022; 37:575-585. [PMID: 35949141 PMCID: PMC10074756 DOI: 10.1177/02692163221115331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Understanding how socioeconomic position influences the symptoms and concerns of patients approaching the end of life is important for planning more equitable care. Data on this relationship is lacking, particularly for patients with non-cancer conditions. AIM To analyse the association between socioeconomic position and the symptoms and concerns of older adult patients seen by specialist palliative care. DESIGN Secondary analysis of cross-sectional, routinely collected electronic patient data. We used multivariable linear regression with robust standard errors, to predict scores on the three subscales of the Integrated Palliative care Outcome Scale (IPOS; physical symptoms, emotional symptoms and communication and practical concerns) based on patient level of deprivation, measured using Index of Multiple Deprivation. SETTING/PARTICIPANTS Consecutive inpatients aged 60 years and over, seen by specialist palliative care at two large teaching hospitals in London between 1st January 2016 and 31st December 2019. RESULTS Seven thousand eight hundred and sixty patients were included, 38.3% had cancer. After adjusting for demographic and clinical characteristics, patients living in the most deprived areas had higher (worse) predicted mean scores on the communication and practical subscale than patients living in the least deprived areas, 5.38 (95% CI: 5.10, 5.65) compared to 4.82 (4.62, 5.02) respectively. This effect of deprivation diminished with increasing age. Deprivation was not associated with scores on the physical or emotional symptoms subscales. CONCLUSIONS Targetting resources to address practical and communication concerns could be a strategy to reduce inequalities. Further research in different hospitals and across different settings using patient centred outcome measures is needed to examine inequalities.
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Affiliation(s)
- Joanna M Davies
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.,King's College Hospital NHS Foundation Trust, London, UK
| | - Christina Ramsenthaler
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.,Faculty of Health Sciences, Institute of Nursing, Zurich University of Applied Sciences, Winterthur, Switzerland.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Wendy Prentice
- King's College Hospital NHS Foundation Trust, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Fliss Em Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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Bayly J, Bradshaw A, Fettes L, Omarjee M, Talbot-Rice H, Walshe C, Sleeman KE, Bajwah S, Dunleavy L, Hocaoglu M, Oluyase A, Garner I, Cripps RL, Preston N, Fraser LK, Murtagh FE, Higginson IJ, Maddocks M. Understanding the impact of the Covid-19 pandemic on delivery of rehabilitation in specialist palliative care services: An analysis of the CovPall-Rehab survey data. Palliat Med 2022; 36:319-331. [PMID: 34964384 DOI: 10.1177/02692163211063397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Palliative rehabilitation involves multi-professional processes and interventions aimed at optimising patients' symptom self-management, independence and social participation throughout advanced illness. Rehabilitation services were highly disrupted during the Covid-19 pandemic. AIM To understand rehabilitation provision in palliative care services during the Covid-19 pandemic, identifying and reflecting on adaptative and innovative practice to inform ongoing provision. DESIGN Cross-sectional national online survey. SETTING/PARTICIPANTS Rehabilitation leads for specialist palliative care services across hospice, hospital, or community settings, conducted from 30/07/20 to 21/09/2020. FINDINGS 61 completed responses (England, n = 55; Scotland, n = 4; Wales, n = 1; and Northern Ireland, n = 1) most frequently from services based in hospices (56/61, 92%) providing adult rehabilitation. Most services (55/61, 90%) reported rehabilitation provision becoming remote during Covid-19 and half reported reduced caseloads. Rehabilitation teams frequently had staff members on sick-leave with suspected/confirmed Covid-19 (27/61, 44%), redeployed to other services/organisations (25/61, 41%) or furloughed (15/61, 26%). Free text responses were constructed into four themes: (i) fluctuating shared spaces; (ii) remote and digitised rehabilitation offer; (iii) capacity to provide and participate in rehabilitation; (iv) Covid-19 as a springboard for positive change. These represent how rehabilitation services contracted, reconfigured, and were redirected to more remote modes of delivery, and how this affected the capacity of clinicians and patients to participate in rehabilitation. CONCLUSION This study demonstrates how changes in provision of rehabilitation during the pandemic could act as a springboard for positive changes. Hybrid models of rehabilitation have the potential to expand the equity of access and reach of rehabilitation within specialist palliative care.
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Affiliation(s)
- Joanne Bayly
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.,St Barnabas Hospices, Worthing, UK
| | - Andy Bradshaw
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Lucy Fettes
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Muhammed Omarjee
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | | | | | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | | | - Mevhibe Hocaoglu
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Adejoke Oluyase
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | | | - Rachel L Cripps
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | | | - Lorna K Fraser
- Martin House Research Centre, Department of Health Sciences, University of York, York, UK
| | - Fliss Em Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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van Steijn D, Pons Izquierdo JJ, Garralda Domezain E, Sánchez-Cárdenas MA, Centeno Cortés C. Population's Potential Accessibility to Specialized Palliative Care Services: A Comparative Study in Three European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910345. [PMID: 34639645 PMCID: PMC8507925 DOI: 10.3390/ijerph181910345] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Palliative care is a priority for health systems worldwide, yet equity in access remains unknown. To shed light on this issue, this study compares populations' driving time to specialized palliative care services in three countries: Ireland, Spain, and Switzerland. METHODS Network analysis of the population's driving time to services according to geolocated palliative care services using Geographical Information System (GIS). Percentage of the population living within a 30-min driving time, between 30 and 60 minutes, and over 60 min were calculated. RESULTS The percentage of the population living less than thirty minutes away from the nearest palliative care provider varies among Ireland (84%), Spain (79%), and Switzerland (95%). Percentages of the population over an hour away from services were 1.87% in Spain, 0.58% in Ireland, and 0.51% in Switzerland. CONCLUSION Inequities in access to specialized palliative care are noticeable amongst countries, with implications also at the sub-national level.
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Affiliation(s)
- Danny van Steijn
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, 31009 Pamplona, Navarra, Spain; (J.J.P.I.); (E.G.D.); (M.A.S.-C.); (C.C.C.)
- Navarra Institute for Health Research (IdiSNA), Recinto de Complejo Hospitalario de Navarra C/Irunlarrea, 3, 31008 Pamplona, Navarra, Spain
- Correspondence:
| | - Juan José Pons Izquierdo
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, 31009 Pamplona, Navarra, Spain; (J.J.P.I.); (E.G.D.); (M.A.S.-C.); (C.C.C.)
- School of Humanities and Social Sciences, University of Navarra, 31009 Pamplona, Navarra, Spain
| | - Eduardo Garralda Domezain
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, 31009 Pamplona, Navarra, Spain; (J.J.P.I.); (E.G.D.); (M.A.S.-C.); (C.C.C.)
- Navarra Institute for Health Research (IdiSNA), Recinto de Complejo Hospitalario de Navarra C/Irunlarrea, 3, 31008 Pamplona, Navarra, Spain
| | - Miguel Antonio Sánchez-Cárdenas
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, 31009 Pamplona, Navarra, Spain; (J.J.P.I.); (E.G.D.); (M.A.S.-C.); (C.C.C.)
- Navarra Institute for Health Research (IdiSNA), Recinto de Complejo Hospitalario de Navarra C/Irunlarrea, 3, 31008 Pamplona, Navarra, Spain
| | - Carlos Centeno Cortés
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, 31009 Pamplona, Navarra, Spain; (J.J.P.I.); (E.G.D.); (M.A.S.-C.); (C.C.C.)
- Navarra Institute for Health Research (IdiSNA), Recinto de Complejo Hospitalario de Navarra C/Irunlarrea, 3, 31008 Pamplona, Navarra, Spain
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Cross SH, Kaufman BG, Quest TE, Warraich HJ. National Trends in Hospice Facility Deaths in the United States, 2003-2017. J Pain Symptom Manage 2021; 61:350-357. [PMID: 32858165 DOI: 10.1016/j.jpainsymman.2020.08.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 11/16/2022]
Abstract
CONTEXT Hospice facilities are increasingly preferred as a location of death, but little is known about the characteristics of patients who die in these facilities in the U.S. OBJECTIVES We sought to examine the trends and factors associated with death in a hospice facility. METHODS Retrospective cross-sectional study using mortality data for years 2003-2017 for deaths attributed to natural causes in the U.S. RESULTS The proportion of natural deaths occurring in hospice facilities increased from 0.2% in 2003 to 8.3% in 2017, resulting in nearly 1.7 million deaths during this time frame. Females had increased odds of hospice facility deaths (odds ratio [OR] = 1.04; 95% CI = 1.04, 1.05). Nonwhite race was associated with lower odds of hospice facility death (black [OR = 0.915; 95% CI = 0.890, 0.940]; Native American [OR = 0.559; 95% CI = 0.515, 0.607]; and Asian [OR = 0.655; 95% CI = 0.601, 0.713]). Being married was associated with hospice facility death (OR = 1.06; 95% CI = 1.04, 1.07). Older age was associated with increased odds of hospice facility death (85 and older [OR = 1.40; 95% CI = 1.39, 1.41]). Having at least some college education was associated with increased odds of hospice facility death (OR = 1.13; 95% CI = 1.11, 1.15). Decedents from cardiovascular disease had the lowest odds of hospice facility death (OR = 0.278; 95% CI = 0.274, 0.282). CONCLUSION Hospice facility deaths increased among all patient groups; however, striking differences exist by age, sex, race, marital status, education level, cause of death, and geography. Factors underlying these disparities should be examined.
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Affiliation(s)
- Sarah H Cross
- Sanford School of Public Policy, Duke University, Durham, North Carolina, USA.
| | - Brystana G Kaufman
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, USA; Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA
| | - Tammie E Quest
- Department of Emergency Medicine, Emory University, Atlanta, Georgia, USA; Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Haider J Warraich
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Cardiology Section, Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA
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Hutson SP, Golden A, Odoi A. Geographic distribution of hospice, homecare, and nursing home facilities and access to end-of-life care among persons living with HIV/AIDS in Appalachia. PLoS One 2020; 15:e0243814. [PMID: 33315923 PMCID: PMC7735579 DOI: 10.1371/journal.pone.0243814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 11/29/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Access to healthcare services, from diagnosis through end of life (EOL), is important among persons living with Human Immunodeficiency Syndrome (HIV) and Acquired Immunodeficiency Syndrome (AIDS) (PLWHA). However, little is known about the availability of hospice services in Appalachian areas. Therefore, the objective of this study is to describe the geographic distribution of hospice, homecare and nursing home facilities in order to demonstrate current existence of and access to resources for EOL care among PLWHA in the Appalachian regions of Tennessee and Alabama. METHODS This paper reports on the second aim of a larger sequential, mixed methods qualitative-quantitative (qual→quan) study. Data from advance care planning (ACP) surveys were collected by both electronic (n = 28) and paper copies (n = 201) and, among other things, obtained information on zip codes of residence of PLWHA. This enabled assessment of the geographic distribution of residences of PLWHA in relation to the distribution of healthcare services such as hospice and home healthcare services. Hospice and Home Healthcare data were obtained from the Tennessee and Alabama Departments of Health. The street addresses of these facilities were used to geocode and map the geographic distributions of the facilities using Street Map USA. Travel times to Hospice and Home Healthcare facilities were computed and mapped using ArcGIS 10.3. RESULTS We identified a total of 32 hospice and 69 home healthcare facilities in the Tennessee Appalachian region, while the Alabama Appalachian region had a total of 110 hospice and 86 home healthcare facilities. Most care facilities were located in urban centers. The distribution of care facilities was worse in Tennessee with many counties having no facilities, requiring up to an hour drive time to reach patients. A total of 86% of the PLWHA indicated preference to die at home. CONCLUSIONS Persons living with HIV/AIDS in Appalachia face a number of challenges at the end of life that make access to EOL services difficult. Although respondents indicated a preference to die at home, the hospice/homecare infrastructure and resources are overwhelmingly inadequate to meet this need. There is need to improve access to EOL care in the Appalachian regions of both Tennessee and Alabama although the need is greater in Tennessee.
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Affiliation(s)
- Sadie P. Hutson
- College of Nursing, University of Tennessee, Knoxville, Tennessee, United States of America
| | - Ashley Golden
- Oak Ridge Associated Universities, Oak Ridge, Tennessee, United States of America
| | - Agricola Odoi
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee Institute of Agriculture, Knoxville, Tennessee, United States of America
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