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

doi:10.1136/bmjspcare-2019-001967

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

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Abstract

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 language	English
Pages (from-to)	462-468
Number of pages	7
Journal	BMJ Supportive and Palliative Care
Volume	10
Issue number	4
Early online date	2019
DOIs	https://doi.org/10.1136/bmjspcare-2019-001967
Publication status	Published - 1 Dec 2020

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Keywords

elderly
palliative care
primary care
public health

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10.1136/bmjspcare-2019-001967Licence: CC BY-NC

2019_12_BMJSuppPallCare_deNooijerKFinal published version, 251 KBLicence: CC BY-NC

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SRP4: Strategic Research Programme: End-of-life in cancer and non-cancer patients: public health, health services and clinical research. Addressing present and future challenges in palliative care.
Deliens, L., Cohen, J., Van den Block, L., Pardon, K., Deliens, L., Cohen, J., Van den Block, L., Chambaere, K., Bilsen, J., Deschepper, R., Rietjens, J. A. C., Sterckx, S., Theuns, P., Vander Stichele, R. & Mortier, F.
1/11/12 → 31/10/24
Project: Fundamental

Cite this

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

abstract = "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.",

keywords = "elderly, palliative care, primary care, public health",

author = "{de Nooijer}, Kim and Lara Pivodic and Luc Deliens and Guido Miccinesi and {Vega Alonso}, Tomas and Sarah Moreels and {Van den Block}, Lieve",

note = "{\textcopyright} 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.",

year = "2020",

month = dec,

day = "1",

doi = "10.1136/bmjspcare-2019-001967",

language = "English",

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pages = "462--468",

journal = "BMJ Supportive and Palliative Care",

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TY - JOUR

T1 - Primary palliative care for older people in three European countries

T2 - a mortality follow-back quality study

AU - de Nooijer, Kim

AU - Pivodic, Lara

AU - Deliens, Luc

AU - Miccinesi, Guido

AU - Vega Alonso, Tomas

AU - Moreels, Sarah

AU - Van den Block, Lieve

PY - 2020/12/1

Y1 - 2020/12/1

N2 - 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.

AB - 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.

KW - elderly

KW - palliative care

KW - primary care

KW - public health

U2 - 10.1136/bmjspcare-2019-001967

DO - 10.1136/bmjspcare-2019-001967

M3 - Article

C2 - 31619438

SN - 2045-435X

VL - 10

SP - 462

EP - 468

JO - BMJ Supportive and Palliative Care

JF - BMJ Supportive and Palliative Care

IS - 4

ER -

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

Abstract

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Projects

SRP4: Strategic Research Programme: End-of-life in cancer and non-cancer patients: public health, health services and clinical research. Addressing present and future challenges in palliative care.

Cite this