Reducing avoidable admissions in rural community palliative care: a pilot study of care coordination by General Practice registrars

Abstract

Objective: To investigate the feasibility of using a General Practice registrar (GPR) to coordinate rural palliative care services. Design: A quasi-experimental design was used. Intervention group participants received the GPR service, which involved liaison among the patient, family, General Practitioner, specialist palliative care team and community nurses. Specified risk assessment, care planning and continuity of care were provided. Patients in the comparison group received the standard service. Setting: Rural community palliative care. Participants: One hundred and ninety-one rural community palliative care patients (99 intervention and 92 control patients). Main outcome measures: Hospital admissions per 100 patient-days, bed-days per 100 patient-days and proportion of deaths at home. Results: Patients receiving standard care were twice as likely to spend ≥8 bed-days in hospital (OR 2.09 (95%CI 1.10–3.97); P = 0.02) and were more likely to have ≥ 2 admissions to hospital (OR 3.37 (95%CI 1.83–6.21); P < 0.001), per 100 patient-days than the intervention group after adjusting for diagnosis group (cancer or not) and residence in residential aged care. Controls were significantly less likely to die at home than the intervention group (OR 0.41 (95%CI 0.20–0.86); P = 0.02). Conclusion: This is a small proof of concept pilot study limited by lack of randomisation. The results demonstrate the feasibility of using a GPR to manage continuity of care for rural community palliative care patients. Given the potential confounding factors, further investigation via a larger randomised trial is required.