Evaluation of a pilot of nurse practitioner led, GP supported rural palliative care provision

Mitchell, Geoffrey Keith, Senior, Hugh Edgar, Bibo, Michael Peter, Makoni, Blessing, Young, Sharleen Nicole, Rosenberg, John Patrick and Yates, Patsy (2016) Evaluation of a pilot of nurse practitioner led, GP supported rural palliative care provision. BMC Palliative Care, 15 1: 1-11. doi:10.1186/s12904-016-0163-y

Author Mitchell, Geoffrey Keith
Senior, Hugh Edgar
Bibo, Michael Peter
Makoni, Blessing
Young, Sharleen Nicole
Rosenberg, John Patrick
Yates, Patsy
Title Evaluation of a pilot of nurse practitioner led, GP supported rural palliative care provision
Journal name BMC Palliative Care   Check publisher's open access policy
ISSN 1472-684X
Publication date 2016-11-09
Sub-type Article (original research)
DOI 10.1186/s12904-016-0163-y
Open Access Status DOI
Volume 15
Issue 1
Start page 1
End page 11
Total pages 11
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Formatted abstract
Background: Providing end of life care in rural areas is challenging. We evaluated in a pilot whether nurse practitioner (NP)-led care, including clinical care plans negotiated with involved health professionals including the general practitioner(GP), ± patient and/or carer, through a single multidisciplinary case conference (SMCC), could influence patient and health system outcomes.

Methods: Setting - Australian rural district 50 kilometers from the nearest specialist palliative care service.

Participants: Adults nearing the end of life from any cause, life expectancy several months. Intervention- NP led assessment, then SMCC as soon as possible after referral. A clinical care plan recorded management plans for current and anticipated problems and who was responsible for each action. Eligible patients had baseline, 1 and 3 month patient-reported assessment of function, quality of life, depression and carer stress, and a clinical record audit. Interviews with key service providers assessed the utility and feasibility of the service.

Results: Sixty-two patients were referred to the service, forty from the specialist service. Many patients required immediate treatment, prior to both the planned baseline assessment and the planned SMCC (therefore ineligible for enrollment). Only six patients were assessed per protocol, so we amended the protocol. There were 23 case conferences. Reasons for not conducting the case conference included the patient approaching death, or assessed as not having immediate problems. Pain (25 %) and depression (23 %) were the most common symptoms discussed in the case conferences. Ten new advance care plans were initiated, with most patients already having one. The NP or RN made 101 follow-up visits, 169 phone calls, and made 17 referrals to other health professionals. The NP prescribed 24 new medications and altered the dose in nine. There were 14 hospitalisations in the time frame of the project. Participants were satisfied with the service, but the service cost exceeded income from national health insurance alone.

Conclusions: NP-coordinated, GP supported care resulted in prompt initiation of treatment, good follow up, and a care plan where all professionals had named responsibilities. NP coordinated palliative care appears to enable more integrated care and may be effective in reducing hospitalisations.
Keyword Case conferences
General practice
Nurse practitioner
Organisation of care
Palliative care
Primary care
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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