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Utilization of health-care services at the end-of-life
University of Skövde, School of Life Sciences.
University of Skövde, School of Life Sciences.
Faculty of Health Caring Sciences, The Sahlgrenska Academy, Göteborg University, Gothenburg, Sweden.
Department of Mathematical Statistics, Chalmers University of Technology, S-412 96 Gothenburg, Sweden.
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2006 (English)In: Health Policy, ISSN 0168-8510, Vol. 82, no 3, 276-287 p.Article in journal (Refereed) Published
Abstract [en]

End-of-life care poses a growing clinical and policy concern since most people who are dying utilize health-care services during this period of life. Hence, end-of-life care is a common and integral part of the care provided by health-care systems. There is a growing call for the implementation of a palliative approach as an integral part of all end-of-life care. The purpose of this study was thus to provide policy-makers, health-care providers and professional caregivers with increased knowledge about mainstream patterns of health-care utilization during end-of-life. The patterns of use of health-care services in a Swedish population who accessed the health-care system during their last 3 months of life were in this study examined through a retrospective examinations of medical and nursing records (n = 229). We found high prevalences of use of both hospital care, primary care and care provided in people's homes and nearly three quarters of the persons included in the study used between two and three health-care services. However, the probability of using different health-care services was found to be strongly depending on demographic, social, functional and disease related characteristics. The study reveals a considerable use of different health-care services during end-of-life. It is hence essential to, on one hand delineate how such health-care services best can support people at the end-of-life, and on the other hand develop policies which facilitate the process of dying, both in hospitals as well as in peoples’ homes. Implications for policy are discussed.

Place, publisher, year, edition, pages
Elsevier, 2006. Vol. 82, no 3, 276-287 p.
National Category
Medical and Health Sciences
Research subject
Medical sciences
Identifiers
URN: urn:nbn:se:his:diva-1939DOI: 10.1016/j.healthpol.2006.10.003ISI: 000248429800002PubMedID: 17097757Scopus ID: 2-s2.0-34250815669OAI: oai:DiVA.org:his-1939DiVA: diva2:32215
Available from: 2008-04-09 Created: 2008-04-09 Last updated: 2013-04-10Bibliographically approved
In thesis
1. End-of-life care in a Swedish county: patterns of demographic and social conditions, clinical problems and health care use
Open this publication in new window or tab >>End-of-life care in a Swedish county: patterns of demographic and social conditions, clinical problems and health care use
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

There is broad consensus in both international and national policy statements that care provided at end-of-life should be different from care provided during other periods of life. There is a need for comprehensive knowledge about the broad population of individuals who access the public health care system during the last period of life. The purpose of this thesis therefore, is to make a contribution to a broader understanding of the nature of end of-life and end-of-life care for these individuals. The study was undertaken through retrospective examinations of death certificates, medical records and nursing records in a randomly selected sample of adults who accessed the public health care system, and who died in the County of Västra Götaland, Sweden, during 2001. The sample consisted of 229 persons. The majority of individuals in this study were aged eighty or more at time of death. Men died four years younger, and were significantly more likely to live apart from their partners at time of death, whereas women were significantly more likely to live alone. There were also significant differences in residential environment at time of death, with one-half residing in private homes and the other half in residential care facilities, and this environment was significantly associated with many of the variables analyzed in this study. The group in residential care facilities was, on average, nearly 10 years older than those in private homes. The most common places of death were acute care hospitals and residential care facilities. The less old persons more often died at acute care hospitals whereas the oldest group more commonly died at residential care facilities. The likelihood of inpatient care during last three months of life, including the expected number of hospital admissions, was significantly higher among residents of private homes than among individuals in residential care facilities. However, the presence of mental disorder(s), mainly dementia, was associated with less utilization of both inpatient and hospital-based outpatient care, regardless of residence. Conversely, the likelihood of using outpatient primary care services was significantly higher among residents of residential care facilities than among those in private homes. Factors such as advancing age, ADL-dependency, and living alone increased the likelihood of receiving care at residential care facilities, whereas presence of neoplasm(s) and musculoskeletal disease(s) increased the likelihood of care in a private home. The mean number of all health care services used was 2.67. A wide range of highly prevalent symptoms and problems was identified in the study group, especially among persons who were ADL-dependent. A specific turning point, reflecting onset of the dying process and reorientation of care, was documented in almost three-quarters of the medical or nursing records. Two thirds of these turning points were documented within the last week of life. Findings from this study provide policymakers, health care providers, and professional caregivers with both a reminder and a framework which may contribute to a more mindful and comprehensive understanding of commonplace end-of-life concerns. It is, in fact, suggested that the public health care system as a whole take greater note of the present situation and that it proactively focus on the development of standards for end-of-life care. Its content should be formulated and based on systematic and detailed insights into the identities of the individuals who utilize the health care system at the end of life, where and from whom they receive care, and most importantly, the nature of their problems and needs. Moreover, steps must be taken to continually audit end-of-life care provided by the public health care system, with an objective to constantly improve the scope, quality, and trustworthiness of its services

Place, publisher, year, edition, pages
Göteborgs Unversitet, Institute of Health Care Sciences, 2006
Keyword
End-of-life, end-of-life care, demographics, social conditions, health care utilization, places of death, clinical problems, turning point
National Category
Nursing
Research subject
Humanities and Social sciences
Identifiers
urn:nbn:se:his:diva-2026 (URN)91-628-7038-6 (ISBN)
Public defence
(English)
Available from: 2008-05-07 Created: 2008-05-07 Last updated: 2010-04-14

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