Primary care contacts, continuity, identification of palliative care needs, and hospital use: a population-based cohort study in people dying with dementia

This article aims to illustrate the importance of continuity of care, and its association with unplanned hospital admissions in people dying from dementia.¹ As we have touched upon a few key aspects of this issue regarding this challenging group of care recipients, we have discussed possible solutions and the situation in our country.

A quality marker of good end-of-life care is that patients can die and be cared for in their preferred setting throughout their final days.^2-3 According to the depicted results, it could be inferred, “No home” death was significantly higher in the group with multiple unplanned hospital admissions in the last 90 days, suggesting poor end-of-life quality. Furthermore, participants, who live in rural areas, are admitted more frequently to hospitals, In line with current literature.^4-5.

Higher healthcare needs or inadequate service integration may be the cause of patients' frequent hospital admissions and higher GP visits. In either case, strategies to improve continuity of care, particularly in residential settings, could lead to less frequent hospital transitions and higher quality of life. Primary care services delivered in multidisciplinary teams are likely to contribute to reducing unnecessary hospital admission at the end of life by facilitating timely access to patient-centered care.

Lastly, the Integration of home-based care services into the healthcare system may enhance the quality of end-of-life care for this population due to the vulnerable state of dementia patients. Programs to give and instruct accessible home-based care services might be also quite beneficial in our country, Iran, especially for senior citizens who live in remote rural areas or those who have significant cognitive deterioration. There are however potential barriers to home care services, including education barriers, implementation barriers such as distrust among the community towards non-physician experts, and policy barriers such as prioritizing hospital services over community services and lack of insurance coverage.

References

1. Leniz J, Gulliford M, Higginson IJ, Bajwah S, Yi D, Gao W, Sleeman KE. Primary care contacts, continuity, identification of palliative care needs, and hospital use: a population-based cohort study in people dying with dementia. Br J Gen Pract 2022; 72(722): e684–92. doi: 10.3399/BJGP.2021.0715.
2. Fereidouni A, Salesi M, Rassouli M et al. Preferred place of death and end-of-life care for adult cancer patients in Iran: A cross-sectional study. Frontiers in Oncology. 2022;12.
3. Sheridan R, Roman E, Smith AG et al. Preferred and actual place of death in haematological malignancies: a report from the UK haematological malignancy research network. BMJ Supportive & Palliative Care. 2021;11(1):7-16.
4. Biem HJ, Hadjistavropoulos H, Morgan D, Biem HB, Pong RW. Breaks in continuity of care and the rural senior transferred for medical care under regionalisation. International Journal of Integrated Care 2003;3.
5. Van Servellen G, Fongwa M, Mockus D’Errico E. Continuity of care and quality care outcomes for people experiencing chronic conditions: A literature review. Nursing & Health Sciences 2006; 8(3):185-95.