Health service utilisation during the last year of life: a prospective, longitudinal study of the pathways of patients with chronic kidney disease stages 3-5
Abstract Background Chronic kidney disease (CKD) is a growing global problem affecting around 10% of many countries’ populations. Providing appropriate palliative care services (PCS) to those with advanced kidney disease is becoming paramount. Palliative/supportive care alongside usual CKD clinical...
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| Format: | Article |
| Language: | English |
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BMC
2018-04-01
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| Series: | BMC Palliative Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12904-018-0310-8 |
| _version_ | 1811322501708382208 |
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| author | Shirley Chambers Helen Healy Wendy E. Hoy Adrian Kark Sharad Ratanjee Geoffrey Mitchell Carol Douglas Patsy Yates Ann Bonner |
| author_facet | Shirley Chambers Helen Healy Wendy E. Hoy Adrian Kark Sharad Ratanjee Geoffrey Mitchell Carol Douglas Patsy Yates Ann Bonner |
| author_sort | Shirley Chambers |
| collection | DOAJ |
| description | Abstract Background Chronic kidney disease (CKD) is a growing global problem affecting around 10% of many countries’ populations. Providing appropriate palliative care services (PCS) to those with advanced kidney disease is becoming paramount. Palliative/supportive care alongside usual CKD clinical treatment is gaining acceptance in nephrology services although the collaboration with and use of PCS is not consistent. Methods The goal of this study was to track and quantify the health service utilisation of people with CKD stages 3-5 over the last 12 months of life. Patients were recruited from a kidney health service (Queensland, Australia) for this prospective, longitudinal study. Data were collected for 12 months (or until death, whichever was sooner) during 2015-17 from administrative health sources. Emergency department presentations (EDP) and inpatient admissions (IPA) (collectively referred to as critical events) were reviewed by two Nephrologists to gauge if the events were avoidable. Results Participants (n = 19) with a median age of 78 years (range 42-90), were mostly male (63%), 79% had CKD stage 5, and were heavy users of health services during the study period. Fifteen patients (79%) collectively recorded 44 EDP; 61% occurred after-hours, 91% were triaged as imminently and potentially life-threatening and 73% were admitted. Seventy-four IPA were collectively recorded across 16 patients (84%); 14% occurred on weekends or public holidays. Median length of stay was 3 days (range 1-29). The median number of EDP and IPA per patient was 1 and 2 (range 0-12 and 0-20) respectively. The most common trigger to both EDP (30%) and IPA (15%) was respiratory distress. By study end 37% of patients died, 63% were known to PCS and 11% rejected a referral to a PCS. All critical events were deemed unavoidable. Conclusions Few patients avoided using acute health care services in a 12 month period, highlighting the high service needs of this cohort throughout the long, slow decline of CKD. Proactive end-of-life care earlier in the disease trajectory through integrating renal and palliative care teams may avoid acute presentations to hospital through better symptom management and planned care pathways. |
| first_indexed | 2024-04-13T13:37:16Z |
| format | Article |
| id | doaj.art-a431a315dd4d44faab08fb4d096d8852 |
| institution | Directory Open Access Journal |
| issn | 1472-684X |
| language | English |
| last_indexed | 2024-04-13T13:37:16Z |
| publishDate | 2018-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Palliative Care |
| spelling | doaj.art-a431a315dd4d44faab08fb4d096d88522022-12-22T02:44:46ZengBMCBMC Palliative Care1472-684X2018-04-0117111110.1186/s12904-018-0310-8Health service utilisation during the last year of life: a prospective, longitudinal study of the pathways of patients with chronic kidney disease stages 3-5Shirley Chambers0Helen Healy1Wendy E. Hoy2Adrian Kark3Sharad Ratanjee4Geoffrey Mitchell5Carol Douglas6Patsy Yates7Ann Bonner8Faculty of Health, Queensland University of TechnologyKidney Health Service, Metro North Hospital and Health Service, Queensland HealthNational Health and Medical Research Council, Chronic Kidney Disease Centre for Research ExcellenceKidney Health Service, Metro North Hospital and Health Service, Queensland HealthKidney Health Service, Metro North Hospital and Health Service, Queensland HealthNational Health and Medical Research Council, Centre for Research Excellence in End of Life CarePalliative Care Service, Royal Brisbane and Women’s Hospital, Queensland HealthFaculty of Health, Queensland University of TechnologyFaculty of Health, Queensland University of TechnologyAbstract Background Chronic kidney disease (CKD) is a growing global problem affecting around 10% of many countries’ populations. Providing appropriate palliative care services (PCS) to those with advanced kidney disease is becoming paramount. Palliative/supportive care alongside usual CKD clinical treatment is gaining acceptance in nephrology services although the collaboration with and use of PCS is not consistent. Methods The goal of this study was to track and quantify the health service utilisation of people with CKD stages 3-5 over the last 12 months of life. Patients were recruited from a kidney health service (Queensland, Australia) for this prospective, longitudinal study. Data were collected for 12 months (or until death, whichever was sooner) during 2015-17 from administrative health sources. Emergency department presentations (EDP) and inpatient admissions (IPA) (collectively referred to as critical events) were reviewed by two Nephrologists to gauge if the events were avoidable. Results Participants (n = 19) with a median age of 78 years (range 42-90), were mostly male (63%), 79% had CKD stage 5, and were heavy users of health services during the study period. Fifteen patients (79%) collectively recorded 44 EDP; 61% occurred after-hours, 91% were triaged as imminently and potentially life-threatening and 73% were admitted. Seventy-four IPA were collectively recorded across 16 patients (84%); 14% occurred on weekends or public holidays. Median length of stay was 3 days (range 1-29). The median number of EDP and IPA per patient was 1 and 2 (range 0-12 and 0-20) respectively. The most common trigger to both EDP (30%) and IPA (15%) was respiratory distress. By study end 37% of patients died, 63% were known to PCS and 11% rejected a referral to a PCS. All critical events were deemed unavoidable. Conclusions Few patients avoided using acute health care services in a 12 month period, highlighting the high service needs of this cohort throughout the long, slow decline of CKD. Proactive end-of-life care earlier in the disease trajectory through integrating renal and palliative care teams may avoid acute presentations to hospital through better symptom management and planned care pathways.http://link.springer.com/article/10.1186/s12904-018-0310-8Chronic kidney diseasePalliative careSupportive careConservative careEnd of lifePatient tracking |
| spellingShingle | Shirley Chambers Helen Healy Wendy E. Hoy Adrian Kark Sharad Ratanjee Geoffrey Mitchell Carol Douglas Patsy Yates Ann Bonner Health service utilisation during the last year of life: a prospective, longitudinal study of the pathways of patients with chronic kidney disease stages 3-5 BMC Palliative Care Chronic kidney disease Palliative care Supportive care Conservative care End of life Patient tracking |
| title | Health service utilisation during the last year of life: a prospective, longitudinal study of the pathways of patients with chronic kidney disease stages 3-5 |
| title_full | Health service utilisation during the last year of life: a prospective, longitudinal study of the pathways of patients with chronic kidney disease stages 3-5 |
| title_fullStr | Health service utilisation during the last year of life: a prospective, longitudinal study of the pathways of patients with chronic kidney disease stages 3-5 |
| title_full_unstemmed | Health service utilisation during the last year of life: a prospective, longitudinal study of the pathways of patients with chronic kidney disease stages 3-5 |
| title_short | Health service utilisation during the last year of life: a prospective, longitudinal study of the pathways of patients with chronic kidney disease stages 3-5 |
| title_sort | health service utilisation during the last year of life a prospective longitudinal study of the pathways of patients with chronic kidney disease stages 3 5 |
| topic | Chronic kidney disease Palliative care Supportive care Conservative care End of life Patient tracking |
| url | http://link.springer.com/article/10.1186/s12904-018-0310-8 |
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