title: A palliative medicine program in a community setting: 12 points from the first 12 months.
abstract: This paper reports the first year's experience of a consultative, interdisciplinary, integrated palliative medicine program in a community hospital system. Prospective data collection was performed on 308 consecutive consultations. A computer database was developed and used to analyze demographics, reason for consultation, complexity of medical problems, current medications and allergies, physical suffering, spiritual concerns, personal and family concerns, consult recommendations, and mortality. In addition, data were collected on patient rating of the severity of physical symptoms, pain, spiritual suffering, and personal and family suffering; this data also was analyzed using the database. Cancer was the most frequent diagnosis (34 percent) and pain the most common reason for consultation (43 percent). Population medians were identified as follows: five (range, 1 to 10) acute medical problems; three (range, 1 to 10) chronic medical problems; and one (range, 0 to 10) medication allergy/intolerance. Patients were taking a median of 10 (range, 0 to 29) medications, including a median of two analgesics. Eighty percent could communicate concerning physical symptoms and had a median of two (range, 0 to 7) bothersome symptoms, with pain the most frequent. Fifty percent or fewer could rate physical suffering, pain, hope, spiritual suffering, or personal/family suffering using a 0 to 10 scale at consultation. Individual patient ratings provided over time for physical suffering, pain, hope, spiritual suffering, and personal/family suffering were available for less than 25 percent. A median of eight recommendations was made for each consultation, with medication changes suggested for 84 percent. For those known to have died, the median survival from time of consultation to death was 11 days.
authors.affiliation: Advanced Illness Assistance Team, Blount Memorial Hospital, Maryville, Tennessee, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Cowan
authors.forename: Debbie
authors.initials: D
authors.lastname: Burns
authors.forename: Teresa Walker
authors.initials: TW
authors.lastname: Palmer
authors.forename: Jerry
authors.initials: J
authors.lastname: Scott
authors.forename: Emily
authors.initials: E
authors.lastname: Feeback
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D017281:Cost of Illness; D004342:Drug Hypersensitivity / Q000453:epidemiology; D004358:Drug Therapy / Q000706:statistics & numerical data; D005195:Family Relations; D005260:Female; D005500:Follow-Up Studies; D006764:Hospitals, Community / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends*; D009026:Mortality / Q000639:trends*; D016311:Outliers, DRG / Q000706:statistics & numerical data; D010147:Pain Measurement / Q000706:statistics & numerical data; D010166:Palliative Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D016730:Program Development; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D029181:Spirituality; D016019:Survival Analysis; D013714:Tennessee / Q000453:epidemiology