Primary palliative care for older people in three European countries: a mortality follow-back quality study

Kim de Nooijer, Lara Pivodic, Luc Deliens, Guido Miccinesi, Tomas Vega Alonso, Sarah Moreels, Lieve Van den Block

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)
48 Downloads (Pure)


BACKGROUND: Many older people with serious chronic illnesses experience complex health problems for which palliative care is indicated. We aimed to examine the quality of primary palliative care for people aged 65-84 years and those 85 years and older who died non-suddenly in three European countries.

METHODS: This is a nationwide representative mortality follow-back study. General practitioners (GPs) belonging to epidemiological surveillance networks in Belgium (BE), Italy (IT) and Spain (ES) (2013-2015) registered weekly all deaths in their practices. We included deaths of people aged 65 and excluded sudden deaths judged by GPs. We applied a validated set of quality indicators.

RESULTS: GPs registered 3496 deaths, of which 2329 were non-sudden (1126 aged 65-84, 1203 aged 85+). GPs in BE (reference category) reported higher scores than IT across almost all indicators. Differences with ES were not consistent. The score in BE particularly differed from IT on GP-patient communication (aged 65-84: 61% in BE vs 20% in IT (OR=0.12, 95% CI 0.07 to 0.20) aged 85+: 47% in BE vs 9% in IT (OR=0.09, 95% CI 0.05 to 0.16)). Between BE and ES, we identified a large difference in involvement of palliative care services (aged 65-84: 62% in BE vs 89% in ES (OR=4.81, 95% CI 2.41 to 9.61) aged 85+: 61% in BE vs 77% in ES (OR=3.1, 95% CI 1.71 to 5.53)).

CONCLUSIONS: Considerable country differences were identified in the quality of primary palliative care for older people. The data suggest room for improvement across all countries, particularly regarding pain measurement, GP-patient communication and multidisciplinary meetings.

Original languageEnglish
Pages (from-to)462-468
Number of pages7
JournalBMJ Supportive and Palliative Care
Issue number4
Early online date2019
Publication statusPublished - 1 Dec 2020

Bibliographical note

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.


  • elderly
  • palliative care
  • primary care
  • public health


Dive into the research topics of 'Primary palliative care for older people in three European countries: a mortality follow-back quality study'. Together they form a unique fingerprint.

Cite this