Palliative care service patients are frequently discharged alive. Scarce evidence exists about the patients who have multiple discharges from a community palliative care service.

 

To characterise patients who had multiple community palliative care episodes.

 

Patients alive at discharge from the Sacred Heart Community Palliative Care Team, Sydney, between 1 July 2010- 31 September 2018, were identified using local health records. Univariable and multivariable logistic regression analyses were used to identify patients’ characteristics associated with multiple palliative care episodes. 

Results:

1,095 out of 5,270 patients (20.7%) were discharged alive. Among those, the median number of palliative care episodes was 1 (interquartile range 1-2), with 454 patients (41.5%) discharged more than once (‘frequent users’).

 

At the first discharge, the median age was 77, with 575 (52.5%) female patients. Univariable analyses found frequent users were more likely to be living at their own residence (versus nursing home OR 2.18, 95% CI 1.59-3.03; versus no usual accommodation OR 3.33, 95% CI 2.33-5.0), living alone (versus living with others OR 1.61 95%CI 1.06-2.32), to have malignancy as the primary diagnosis versus non-malignant OR 2.40 95%CI 1.84-3.13) to have been referred by a palliative care service (versus specialist OR 1.56 95%CI 1.18-2.06). 

 

In multivariable analyses, adjusting for all patient characteristics simultaneously, the same factors were significantly associated with frequent services use.

In this study, characteristics such as a patient’s usual accommodation, whether they live alone, primary diagnosis, and referral source were independently associated with frequent community palliative care service users. Further research into why patients are frequent service users may assist in service delivery planning.