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 Access to so-called palliative care is greatest in the New England,
Pacific and mid-Atlantic regions of the U.S., researchers report in
the Journal of Palliative Medicine. Far fewer hospitals have
palliative care programs in the Southern states.
People who live near larger hospitals are also more likely to have
access to palliative care – it’s offered in 90 percent of hospitals
with at least 300 beds but just 56 percent of hospitals with fewer
beds.
While variation in access to palliative care isn’t surprising and
mirrors what happens in many areas of medicine, the study findings
help identify gaps in care that could be improved, said senior
author Dr. Sean Morrison, a researcher in geriatrics and palliative
medicine at Icahn School of Medicine at Mount Sinai in New York.
“Considerable data now demonstrates that when patients receive
palliative care in addition to traditional medical care, they have
improved quality of life, greater satisfaction with their medical
care, are less likely to be re-admitted to the hospital or have to
visit an emergency department, and in certain diseases (i.e. cancer)
have greater survival,” Morrison said by email.
Morrison and colleagues analyzed data from a variety of sources
including the U.S. census and the American Hospital Association as
well as from interviews with hospital administrators and program
directors.
In addition to hospital size, they found institutions’ tax status
was also a significant predictor of access to palliative care.
Not-for-profit and public hospitals were, respectively, 4.8 times
and 7.1 times more likely to have a palliative care program than
for-profit hospitals, the study found.
Regional variation in palliative care was also pretty stark. In New
England, 88 percent of hospitals had palliative care programs, as
did 77 percent of hospitals in the Pacific and mid-Atlantic states.
In the south-central regions, slightly more than 40 percent of
hospitals had programs.
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Overall, access is much better now than it was less than a decade
ago, however.
At the end of 2014, 67 percent of hospitals with 50 beds or more had
palliative care programs, up from 53 percent in a report published
in 2008 and just 15 percent in a 2001 report.
One limitation of the study is that it only assessed whether or not
hospitals had palliative care programs, and lacked detailed
information on how these programs were structured or staffed, how
many patients they treated or the quality of care provided, the
authors acknowledge.
It’s possible, also, that regional variation in palliative care
reflects a larger problem with health disparities, said Joy
Goldsmith, a palliative care and hospice researcher at the
University of Memphis in Tennessee who wasn’t involved in the study.
“Palliative care that is systematically engaged indicates resources
that have been invested in this innovation,” Goldsmith said by
email. “The regions representing the least expansive growth in
palliative care are regions that struggle the most in health
disparities, obesity and comorbidities.”
SOURCE: http://bit.ly/1LUkpQk Journal of Palliative Medicine, online
September 29, 2015.
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