Patient characteristics and palliative care eligibility in public vs. private emergency care: A cross-sectional observational study

TL;DR

This study finds that a significant portion of emergency patients in Brazil are eligible for palliative care, with public hospitals seeing much higher rates than private ones.

Contribution

The study identifies a high prevalence of palliative care eligibility in public emergency departments and highlights unmet care needs.

Findings

37.4% of emergency patients were eligible for palliative care.

Public EDs had 9-fold higher odds of palliative care eligibility compared to private EDs.

Pain was the most reported symptom among eligible patients despite low opioid use.

Abstract

•37.4 % of emergency patients were eligible for palliative care.•Public EDs had 9-fold higher odds of palliative care eligibility.•Pain was the most reported symptom among eligible patients.•Opioid use was low despite high symptom burden in PC patients.•SPICT-BR™ and PPS tools revealed unmet needs in emergency care.

37.4 % of emergency patients were eligible for palliative care.

Public EDs had 9-fold higher odds of palliative care eligibility.

Pain was the most reported symptom among eligible patients.

Opioid use was low despite high symptom burden in PC patients.

SPICT-BR™ and PPS tools revealed unmet needs in emergency care.

The rapid aging of the Brazilian population in recent decades has strained the healthcare system. A lack of chronic patient absorption in primary care has led to overloaded emergency departments, which handle preventable decompensation and care that could be managed at home.

To identify the demand for patients eligible for Palliative Care (PC), among patients in four Emergency Departments (ED) in a metropolitan region in Brazil.

This observational, cross-sectional study involved four emergency departments: two public university hospitals and two private hospitals. Patient data on gender, age, visit reasons, and comorbidities were collected, along with the Supportive and Palliative Care Indicators Tool (SPCIT-BR™), Palliative Performance Scale (PPS) assessments, and opioid use information.

Of the 270 patients, 101 (37.4 %) were eligible for PC. Of these eligible patients, the median age was 70-years, 54.5 % were male and public EDs had 9-fold higher odds of palliative care eligibility. Age, dyspnea, and fever predicted palliative care eligibility.

The present findings demonstrate the necessity of further implementation of palliative care programs, particularly in the public health system. Such integration could lead to a decrease in unnecessary ED visits and home-based care that reflects patient wishes.

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