Are family physician visits and continuity of care associated with acute care use at end-of-life? A population-based cohort study of homecare cancer patients

被引:58
作者
Almaawiy, Ummukulthum [1 ]
Pond, Gregory R. [2 ]
Sussman, Jonathan [2 ]
Brazil, Kevin [3 ]
Seow, Hsien [2 ]
机构
[1] McMaster Univ, Hamilton, ON L8V 5C2, Canada
[2] McMaster Univ, Dept Oncol, Hamilton, ON L8V 5C2, Canada
[3] Queens Univ Belfast, Belfast, Antrim, North Ireland
关键词
Family physician; primary care; continuity of care; hospitalization; cancer; palliative care; TERMINALLY-ILL PATIENTS; PERSONAL CONTINUITY; QUALITY; DEATH; INDICATORS; MEDICINE; INDEXES; PLACE; MODEL; DIE;
D O I
10.1177/0269216313493125
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background: Previous end-of-life cancer research has shown an association between increased family physician continuity of care and reduced use of acute care services; however, it did not focus on a homecare population or control for homecare nursing. Aim: Among end-of-life homecare cancer patients, to investigate the association of family physician continuity with location of death and hospital and emergency department visits in the last 2 weeks of life while controlling for nursing hours. Design: Retrospective population-based cohort study. Setting/participants: Cancer patients with 1 family physician visit in 2006 from Ontario, Canada. Family physician continuity of care was assessed using two measures: Modified Usual Provider of Care score and visits/week. Its association with location of death and hospital and emergency department visits in the last 2 weeks of life was examined using logistic regression. Results: Of 9467 patients identified, the Modified Usual Provider of Care score demonstrated a dose-response relationship with increasing continuity associated with decreased odds of hospital death and visiting the hospital and emergency department in the last 2 weeks of life. More family physician visits/week were associated with lower odds of an emergency department visit in the last 2 weeks of life and hospital death, except for patients with greater than 4 visits/week, where they had increased odds of hospitalizations and hospital deaths. Conclusions: These results demonstrate an association between increased family physician continuity of care and decreased odds of several acute care outcomes in late life, controlling for homecare nursing and other covariates.
引用
收藏
页码:176 / 183
页数:8
相关论文
共 45 条
[31]  
Marshall D, 2008, CAN FAM PHYSICIAN, V54, P1703
[32]  
MCWHINNEY IR, 1995, CAN MED ASSOC J, V152, P361
[33]   The role of general practitioners in continuity of care at the end of life: a qualitative study of terminally ill patients and their next of kin [J].
Michiels, Eva ;
Deschepper, Reginald ;
Van Der Kelen, Greta ;
Bernheim, Jan L. ;
Mortier, Freddy ;
Stichele, Robert Vander ;
Deliens, Luc .
PALLIATIVE MEDICINE, 2007, 21 (05) :409-415
[34]  
Nassif D, 1982, QRB Qual Rev Bull, V8, P11
[35]  
Norman A, 2001, CAN FAM PHYSICIAN, V47, P2009
[36]   AN APPLICATION OF CAPTURE RECAPTURE METHODS TO THE ESTIMATION OF COMPLETENESS OF CANCER REGISTRATION [J].
ROBLES, SC ;
MARRETT, LD ;
CLARKE, EA ;
RISCH, HA .
JOURNAL OF CLINICAL EPIDEMIOLOGY, 1988, 41 (05) :495-501
[37]   Using More End-of-Life Homecare Services is Associated With Using Fewer Acute Care Services A Population-Based Cohort Study [J].
Seow, Hsien ;
Barbera, Lisa ;
Howell, Doris ;
Dy, Sydney M. .
MEDICAL CARE, 2010, 48 (02) :118-124
[38]  
SMEDBY O, 1986, MED CARE, V24, P511
[39]   Encounters with doctors: quantity and quality [J].
Smith, SDM ;
Nicol, KM ;
Devereux, J ;
Cornbleet, MA .
PALLIATIVE MEDICINE, 1999, 13 (03) :217-223
[40]   When death is imminent - Where terminally ill patients with cancer prefer to die and why [J].
Tang, ST .
CANCER NURSING, 2003, 26 (03) :245-251