Journal of the American Medical Directors Association · 2026
Utilization and Post-Admission Duration of Palliative Care Among General Practitioner-Referred Patients: A Retrospective Cohort Study.
СтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Ayalew Animut Alebel, Poudel Arjun, Johnson Keryn, Thepsourinthone Jack, Heer Stacey, Redwood Lisa, Mullan Judy, Bonney Andrew, Morgan Deidre, Yates Patsy, Clark Katherine, Auret Kirsten, Clapham Sabina
Аннотация
OBJECTIVES: To assess palliative care utilization, estimate duration of care, and identify predictors of care duration among general practitioner (GP)-referred patients following commencement of specialist palliative care.
DESIGN: Multicenter retrospective cohort study.
SETTING AND PARTICIPANTS: This study included patients with life-limiting illnesses referred by GPs between July 1, 2019, and June 30, 2024, and who received care from services registered with the Australian Palliative Care Outcomes Collaboration.
METHODS: Two outcomes were assessed: (1) palliative care utilization (inpatient vs community) and (2) duration of palliative care, measured in days. Binary logistic regression identified factors associated with inpatient vs community palliative care utilization, and quantile regression identified predictors of palliative care duration from first admission to death.
RESULTS: Of 25,124 GP-referred patients, 92.2% were admitted to community palliative care and 44.4% died during the study period. Most deaths (81.3%) occurred within 3 months of commencing specialist palliative care. Admission to inpatient care was more likely among patients with cancer and those experiencing distress from breathlessness, nausea, or psychological/spiritual problems, and less likely among those with higher functional status, older age, distress from appetite or fatigue, and family/carer problems. Among decedents, shorter duration of palliative care was associated with inpatient care, functional decline, distress from pain, breathlessness, and family/carer problems.
CONCLUSIONS AND IMPLICATIONS: GP-referred patients were predominantly admitted to community-based palliative care, and most of them received specialist palliative care for a shorter duration than recommended. Future research in primary care, exploring needs-based referral models and referral acceptance, may support timely access and comprehensive care.
DESIGN: Multicenter retrospective cohort study.
SETTING AND PARTICIPANTS: This study included patients with life-limiting illnesses referred by GPs between July 1, 2019, and June 30, 2024, and who received care from services registered with the Australian Palliative Care Outcomes Collaboration.
METHODS: Two outcomes were assessed: (1) palliative care utilization (inpatient vs community) and (2) duration of palliative care, measured in days. Binary logistic regression identified factors associated with inpatient vs community palliative care utilization, and quantile regression identified predictors of palliative care duration from first admission to death.
RESULTS: Of 25,124 GP-referred patients, 92.2% were admitted to community palliative care and 44.4% died during the study period. Most deaths (81.3%) occurred within 3 months of commencing specialist palliative care. Admission to inpatient care was more likely among patients with cancer and those experiencing distress from breathlessness, nausea, or psychological/spiritual problems, and less likely among those with higher functional status, older age, distress from appetite or fatigue, and family/carer problems. Among decedents, shorter duration of palliative care was associated with inpatient care, functional decline, distress from pain, breathlessness, and family/carer problems.
CONCLUSIONS AND IMPLICATIONS: GP-referred patients were predominantly admitted to community-based palliative care, and most of them received specialist palliative care for a shorter duration than recommended. Future research in primary care, exploring needs-based referral models and referral acceptance, may support timely access and comprehensive care.