Original Title: La asistencia a pacientes en la fase final de la vida: revisión sistemática de la literatura y estudio en el medio hospiralario del País Vasco

Authors' objectives: Collect and summarise scientific information appropriate for the analysis of the models of attention given to patients at the end of their life and to know the quality of health care at the moment of death in the different kinds of hospital that exist in the Basque Country: Acure-care hospitals, Home hospitalisation (HAD) and Palliative Care Units (PCU). A secondary aim was to study the consumption of hospital resources during the last six months of life.

Authors' results and conclusions: There are sufficient evidence concerning the efficiency of the care given to patients at the end of their life by specialised teams with regard to controlling pain and other symptoms, and the satisfaction of the patient and his/her carers. The services that coordinate palliative care, as well as the care given in the patient's home and in hospital by specialised teams seem to be more costeffective than conventional forms of care because these reduce the consumption of health resources (fewer diagnostic and therapeutic tests, fewer admissions to hospital and fewer days spent in general hospitals). Of the 486 patients studied during the second part of the evidence, only 57% were diagnosed as having a terminal illness, the median amount of time between the aforementioned diagnoses and death being three days. During the last six months of their life, patients were subject to an median number of admissions (IR:1) and a period in hospital of 24 days (IR:30). In acute-care hospitals, the last admission was made by reason of a "progressive deterioration" while in the HAD and PCU services this was done in order to "control symptoms". The prescription of opiates administered at a fixed rate, laxatives and corticoids, as well as the use of oral and subcutaneous methods in the administering of drugs were significantly lower in acute-care hospitals. Pain was the most frequently assessed symptom, but in PCUs, this was significantly lower. In patients diagnosed as being in agony (52%), the "no specific" treatment (21%) was less frequent than in non-diagnosed patients (59%).

Authors' recommendations: Both the analysis of the evidence published in scientific literature and the result of the survey carried out in the Basque Country, allow us to conclude that the quality of care in conventional hospitalisation is inferior to that provided by specially trained teams. The Basque Health System has started out on the road towards the adequate care of patients at the end of their life. To do this, in addition to establishing PCUs in long and medium stay hospitals, it created the Palliative Care consultant-coordinating teams in acute-care hospitals.

Authors' methods: Quality surveys published between 1990 and February 2002 on the organisation, standards and efficiency of the different kinds of palliative care for cancer patients were compiled. An automatic search was made of Medline, HealthStar, Cochrane Library, Spanish Medical Index, LILACS and DARE. Following this, these surveys were classified according to levels of quality in: Systematic reviews, clinical trials, observational studies and cost studies, and finally, after analysing the abstracts of 383 articles that complied with the criteria for inclusion in our study, 31 were selected in order to draw up the tables of evidence. The second part of the research consisted on a descriptive study based on a retrospective revision of clinical records. The study was carried out doing the first six months of 1997 in acute-care hospitals, HAD and the PCU services of Osakidetza/Basque Health Service. The study dealt with cancer patients who died during hospitalisation. The quality of care was investigated during the last period of hospitalisation, as well as the consumption of resources during the last six months of life. In addition to descriptive variables, other variables were studied relating to the consumption of resources and quality of care. After a stratified random sampling according to the type of care and hospital, absolute and relative frequencies were estimated, as well as their confidence interval in the case of qualitative variables and the mean and standard deviation (DE) or median and interquartile range (IR) in the case of quantitative variables.

Project Status: Completed

Year Published: 2003

URL for published report: https://www.euskadi.eus/contenidos/informacion/2003_osteba_publicacion/es_def/adjuntos/2003/d_03-01_asistencia_fase_final_vida.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Basque Office for Health Technology Assessment (OSTEBA)</p>