Effectiveness of two types of palliative home care in cancer and non-cancer patients: A retrospective population-based study using claims data

Author:

Krause Markus1ORCID,Ditscheid Bianka1,Lehmann Thomas2,Jansky Maximiliane3,Marschall Ursula4,Meißner Winfried5,Nauck Friedemann3,Wedding Ulrich5,Freytag Antje1ORCID

Affiliation:

1. Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany

2. Center for Clinical Studies, Jena University Hospital, Jena, Germany

3. Clinic for Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany

4. BARMER, Wuppertal, Germany

5. Department of Palliative Care, Jena University Hospital, Jena, Germany

Abstract

Background: Comparative effectiveness of different types of palliative homecare is sparsely researched internationally—despite its potential to inform necessary decisions in palliative care infrastructure development. In Germany, specialized palliative homecare delivered by multi-professional teams has increased in recent years and factors beyond medical need seem to drive its involvement and affect the application of primary palliative care, delivered by general practitioners who are supported by nursing services. Aim: To compare effectiveness of primary palliative care and specialized palliative homecare in reducing potentially aggressive interventions at the end-of-life in cancer and non-cancer. Design: Retrospective population-based study with claims data from 95,962 deceased adults in Germany in 2016 using multivariable regression analyses. Settings/participants: Patients having received primary palliative care or specialized palliative homecare (alone or in addition to primary palliative care), for at least 14 days before death, differentiating between cancer and non-cancer patients. Results: Rates of potentially aggressive interventions in most indicators were higher in primary palliative care than in specialized palliative homecare ( p < 0.01), in both cancer and non-cancer patients: death in hospital (odds ratio (OR) 4.541), hospital care (OR 2.720), intensive care treatment (OR 6.749), chemotherapy (OR 2.173), and application of a percutaneous endoscopic gastrostomy (OR 4.476), but not for parenteral nutrition (OR 0.477). Conclusion: Specialized palliative homecare is more strongly associated with reduction of potentially aggressive interventions than primary palliative care in the last days of life. Future research should identify elements of specialized palliative homecare applicable for more effective primary palliative care, too. German Clinical Trials Register (DRKS00014730).

Funder

German Innovations Fund of the Federal Joint Committee in Germany

Publisher

SAGE Publications

Subject

Anesthesiology and Pain Medicine,General Medicine

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