[Identification of palliative needs, complexities and other clinical variables in complex chronic patients in primary care in Andalusia: INCO-Pal study].

OBJECTIVE

To describe palliative care needs, case and palliative complexity, frailty, prognosis, and other relevant clinical variables in complex chronic patients (CCPs) attended in Primary Care in Andalusia.

DESIGN

Descriptive, cross-sectional, multicentre study. SITE: Primary care centres in the eight provinces of Andalusia.

PARTICIPANTS

179 CCPs randomly selected by case management nurses trained in the use of assessment tools.

INTERVENTIONS: Sociodemographic and clinical variables were collected, and validated tools were applied: NECPAL-ICO-CCOMS© for palliative needs, Frágil-VIG for frailty, ICCa for case complexity, IDC-Pal for palliative complexity, and the PROFUND and PPI indices to estimate prognosis.

MAIN MEASUREMENTS: The mean age was 80.59 (±9.764) years, and 54.7% were women. Forty-two point five per cent met NECPAL criteria for advanced PCC. The mean frailty was 0.37 (±0.166). Forty-one point three per cent were classified as complex cases (ICCa) and 26.3% presented high palliative complexity (IDC-Pal). The one-year mortality risk was 45-50% (PROFUND), with an estimated mean survival of 135days (PPI).

RESULTS

Statistically significant differences (P≤0,05) were found in tool scores by sex, presence of cognitive impairment, and caregiver availability. Significant correlations were observed between frailty, complexity, and prognosis.

CONCLUSIONS

A high proportion of CCPs in Primary Care in Andalusia present palliative needs, frailty, and clinical and social complexity, with a limited life expectancy. These findings evidence the need for systematic comprehensive assessments to identify early patients requiring specific palliative care and to optimize the use of health and social care resources.