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End-of-life hospital transfers in out-of-hours general practice.

Korte-Verhoef, M.C. de, Pasman, H.R.W., Schweitzer, B.P.M., Francke, A.L., Onwuteaka-Philipsen, B.D., Deliens, L. End-of-life hospital transfers in out-of-hours general practice. Palliative Medicine: 2012, 26(4) 466. Abstract. 7th World Research Congress of the European Association for Palliative Care (EAPC), 7-9 juni 2012, Trondheim.
Background: During the end of life, many patients experience transfers from home to hospital, and the majority of them die in a hospital. Aim: To explore the reasons for hospital transfers of palliative care patients in out-of-hours general practices. Methods: A retrospective descriptive chart study was conducted during a one-year period (1/11/05-1/11/06) in all 8 out-of-hours general practices of the Amsterdam region (Netherlands). Of the 529 charts of palliative care patients, all sociodemographic, medical characteristics and symptoms were recorded. Multivariable logistic regression analysis was performed to identify variables that were associated with hospital transfers at the end of life. Results: In total, 13% of all palliative care patients for whom an out-of-hours general practitioner (GP) was called were transferred to hospital. Cancer (OR 5.1), cardiovascular problems (OR 8.3), digestive problems (OR 2.5), and endocrine, metabolic and nutritional (EMN) problems (OR 2.5) were significantly associated with hospital transfer for patients for whom an out-of-hours GP was called. Receiving professional nursing care (OR 0.2) and information transfer of the patients own GP to the outof-hours GP (OR 0.4) were significantly associated with staying at home. Most frequent reasons for hospital transfer as noted by the out-of-hours GP were digestive (30%), EMN (19%), and respiratory problems (17%). The most common digestive problem was vomiting (16%) and the most noted problem for EMN was dehydration (16%). Conclusion: In order to anticipate potentially undesirable hospital transfers in out-of-hours general practices, GPs should be alert to digestive, EMN, respiratory and cardiovascular symptoms in palliative care patients. (aut. ref.)