Case conferences between general practitioners and specialist teams to plan end of life care of people with end stage heart failure and lung disease: an exploratory pilot study

Mitchell, Geoffrey, Zhang, Jianzhen, Burridge, Letitia, Senior, Hugh, Miller, Elizabeth, Young, Sharleen, Donald, Maria and Jackson, Claire (2014) Case conferences between general practitioners and specialist teams to plan end of life care of people with end stage heart failure and lung disease: an exploratory pilot study. BMC Palliative Care, 13 1: 24.1-24.7. doi:10.1186/1472-684X-13-24


Author Mitchell, Geoffrey
Zhang, Jianzhen
Burridge, Letitia
Senior, Hugh
Miller, Elizabeth
Young, Sharleen
Donald, Maria
Jackson, Claire
Title Case conferences between general practitioners and specialist teams to plan end of life care of people with end stage heart failure and lung disease: an exploratory pilot study
Journal name BMC Palliative Care   Check publisher's open access policy
ISSN 1472-684X
Publication date 2014-05-05
Sub-type Article (original research)
DOI 10.1186/1472-684X-13-24
Open Access Status DOI
Volume 13
Issue 1
Start page 24.1
End page 24.7
Total pages 7
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2015
Language eng
Formatted abstract
 Background: Most people die of non-malignant disease, but most patients of specialist palliative care services have
cancer. Adequate end of life care for people with non-malignant disease requires acknowledgement of their limited
prognosis and appropriate care planning. Case conferences between specialist palliative care services and GPs
improve outcomes in cancer-based populations. We report a pilot study of case conferences between the patient’s
GP and specialist staff to facilitate care planning for people with end stage heart failure or non-malignant lung
disease in a regional health service in Queensland Australia.
Methods: Single face to face case conferences about patients with a primary diagnosis of advanced heart failure
or respiratory failure from non-malignant disease were conducted between a palliative care consultant, a case
management nurse and the patient’s GP. Annualised rates of service utilisation (emergency department [ED]
presentations, ED discharges back to home, hospital admissions, and admission length of stay) before and after case
conference were calculated. Content and counts of case conference recommendations, and the rate of adherence
to recommendations were also assessed. A process evaluation of case conferences was undertaken.
Results: Twenty-three case conferences involving 21 GPs were conducted between November 2011 and November
2012. One GP refused to participate. Ten patients died, three at home. Of 82 management recommendations made,
55 (67%) were enacted. ED admissions fell from 13.9 per annum (pa) to 2.1 (difference 11.8, 95% CI 2.2-21.3,
p = 0.001); ED admissions leading to discharge home from 3.9 to 0.4 pa (difference 3.5, 95% CI -0.4-7.5, p = 0.05);
hospital admissions from 11.4 to 3.5 pa (difference 7.9, 95% CI 2.2-13.7, p = 0.002); and length of stay from 7.0
to 3.7 days (difference 3.4, 95% CI 0.9-5.8, p = 0.007). Participating health professionals were enthusiastic about
the process.
Conclusions: This pilot is the initial step in the development and testing of a complex intervention based on a
model of integrated care. A single case conference involving the patient’s heart or lung failure team is associated
with significant reductions in service utilization, apparently by improving case coordination, enhancing symptom
management and assessing and managing carer needs. A randomized controlled trial is being developed.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Discipline of General Practice Publications
Official 2015 Collection
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 6 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 7 times in Scopus Article | Citations
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Created: Wed, 21 May 2014, 16:24:08 EST by Dr Jenny (Jianzhen) Zhang on behalf of Discipline of General Practice