How to take better care of individuals at the end of life? A new study has been conducted to determine whether health policies could improve care at the end of life: the results show that some hospitalizations could be avoided thanks to the general practitioner and via a better care coordination.
The study, which was published in the JECH (Journal of Epidemiology and Community Health), was carried out in 4 European countries (The Netherlands, Belgium, Spain, and Italy) between 2009 and 2011 by the Sentinel Networks of General Practitioners. Only non-sudden deaths were taken into account, that is 4791 cases were studied. These doctors noted the circumstances of the death of their patients and the frequency of hospitalization during the last three months of their life.
In all the countries studied, there was a similar percentage of hospitalization in the last 3 months (approximately half of the non-sudden deaths).
However, the percentage of repeated hospitalizations (two or three successive episodes) is less than half in The Netherlands than in the other countries. The preventative action of the General Practitioners against repeated hospitalization is one of the keys, even if it doesn’t seem to be the determining factor. It appears that in The Netherlands, this role is combined with a better coordination of care beginning at the first hospitalization.
In addition, the study emphasizes that there is a lower percentage of hospitalization in the last seven days of life in The Netherlands. The study shows that the general practitioners’ knowledge of the patient’s final wishes regarding the place of his death, as well as the fact of residing in a retirement home offering medical care, are determining factors to avoid being hospitalized at the very end of life.
The study concludes that hospitalizations can be avoided if care is better organized and if individuals at the end of life receive care in their usual environment. Thus, by implementing a more-adapted public health policy, hospitalizations at the end of life could be reduced. These hospitalizations are sometimes carried out against the wishes of some patients and their families, and reducing these episodes could contribute significantly to lowering the cost of care.
