Terminally ill patients who have early access to home-based palliative care have fewer hospital admissions at the end of their lives, raising questions about the fiscal wisdom of time-based restrictions on such services.
Researchers at Curtin University looked at the relationship between time of starting community-based palliative care and the number of hospital stays and emergency department admissions in over 28,000 cancer patients in the Perth area between 2001-11.
They found on average, patients who started community-based palliative care within six months before death had 1.7 unplanned hospital admissions costing the health system $13,959.
This compared to 1.4 visits at a cost of $12,976 (almost $1000 less) for those who started community-based palliative care six months or more before death.
People who started community-based palliative care within six months of death also visited emergency departments more frequently – an average 1.4 visits compared to 1.1 visits.
The findings, published this month in the Journal of Pain and Symptom Management, challenge the idea that putting time restrictions on access to community-based palliative care will reduce costs to the health system.
Some jurisdictions employ temporal limits, such as Queensland which requires patients to have a life expectancy of three months or less, say Cameron Wright and colleagues from the School of Public Health at Curtin University and his co-authors.
However there is strong evidence that hospital care at the end of life is expensive and accounts for a disproportionate amount of health spending, they write.
In contrast, their own findings when viewed at a population level “argue against temporally restricting access to community-based palliative care as earlier initiation may pay dividends in the final few months”.
The findings are supported by studies from Canada which have shown how initiating community-based palliative care more than 6 months before death reduced the need for acute care in the last fortnight of life in a dose- dependent manner and how end-of-life nursing reduced ED presentations in the subsequent week over the final six months of life, they write.
“Although we cannot suggest causation, these findings support a hypothesis that initiation of community-based palliative care at more than six months before death can reduce the number of unplanned hospitalisations at a population level in the six months before death”, the authors conclude.
Meanwhile, Federal Health Minister Greg Hunt has announced a pilot program of home-based palliative care in 10 locations across five states. The $8.3 million Greater Choice for At Home Palliative Care program will include palliative care services from a local GP, palliative, hospital and specialist care support, and community and social services.
The program will be administered through Primary Health Networks in co-ordination with local and state services, as well as aged care providers.