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Original research
Primary palliative care for older people in three European countries: a mortality follow-back quality study
  1. Kim de Nooijer1,
  2. Lara Pivodic1,
  3. Luc Deliens1,2,
  4. Guido Miccinesi3,
  5. Tomas Vega Alonso4,
  6. Sarah Moreels5 and
  7. Lieve Van den Block1
  1. 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
  2. 2 Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
  3. 3 Clinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute, Florence, Italy
  4. 4 Public Health Directorate, Regional Ministry of health (Direccion General de Salud Publica, Conselleria de Sanidad), Castille and Leon, Valladolid, Spain
  5. 5 Epidemiology and Public Health, Health Services Research, Sciensano, Brussels, Belgium
  1. Correspondence to Kim de Nooijer, End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels 1090, Belgium; Kim.De.Nooijer{at}vub.be

Abstract

Background Many older people with serious chronic illnesses experience complex health problems for which palliative care is indicated. We aimed to examine the quality of primary palliative care for people aged 65–84 years and those 85 years and older who died non-suddenly in three European countries.

Methods This is a nationwide representative mortality follow-back study. General practitioners (GPs) belonging to epidemiological surveillance networks in Belgium (BE), Italy (IT) and Spain (ES) (2013–2015) registered weekly all deaths in their practices. We included deaths of people aged 65 and excluded sudden deaths judged by GPs. We applied a validated set of quality indicators.

Results GPs registered 3496 deaths, of which 2329 were non-sudden (1126 aged 65–84, 1203 aged 85+). GPs in BE (reference category) reported higher scores than IT across almost all indicators. Differences with ES were not consistent. The score in BE particularly differed from IT on GP–patient communication (aged 65–84: 61% in BE vs 20% in IT (OR=0.12, 95% CI 0.07 to 0.20) aged 85+: 47% in BE vs 9% in IT (OR=0.09, 95% CI 0.05 to 0.16)). Between BE and ES, we identified a large difference in involvement of palliative care services (aged 65–84: 62% in BE vs 89% in ES (OR=4.81, 95% CI 2.41 to 9.61) aged 85+: 61% in BE vs 77% in ES (OR=3.1, 95% CI 1.71 to 5.53)).

Conclusions Considerable country differences were identified in the quality of primary palliative care for older people. The data suggest room for improvement across all countries, particularly regarding pain measurement, GP–patient communication and multidisciplinary meetings.

  • palliative care
  • elderly
  • primary care
  • public health
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjspcare-2019-001967

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    Footnotes

    • Twitter @KimNooijer

    • Contributors LD, GM, TVA and LVdB designed the study. LVdB, LD and LP contributed to the construction of quality indicators. SM, GM and TVA monitored data collection. KdN and LP analysed the data. All authors contributed to data interpretation. KdN drafted the article. All authors critically reviewed the article and gave final approval of the version to be published.

    • Funding This work was supported by the Research Foundation – Flanders (under grant agreement G.0303.16) and by the AXA Research Fund (Postdoctoral Fellowship to LP). LP is a Postdoctoral Fellow of the Research Foundation – Flanders (no grant number).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval In Belgium, the study protocol was approved by the Ethical Review Board of Brussels University Hospital of the Vrije Universiteit Brussel. In Italy, the ethical approval for data collection was obtained from the Local Ethical Committee Comitato Etico della Azienda Sanitaria Firenze, Tuscany. No ethics approval was required in Spain.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request.