title: Referral patterns and proximity to palliative care inpatient services by level of socio-economic disadvantage. A national study using spatial analysis.
abstract: BACKGROUND
  A range of health outcomes at a population level are related to differences in levels of social disadvantage. Understanding the impact of any such differences in palliative care is important. The aim of this study was to assess, by level of socio-economic disadvantage, referral patterns to specialist palliative care and proximity to inpatient services.
  
  
  METHODS
  All inpatient and community palliative care services nationally were geocoded (using postcode) to one nationally standardised measure of socio-economic deprivation - Socio-Economic Index for Areas (SEIFA; 2006 census data). Referral to palliative care services and characteristics of referrals were described through data collected routinely at clinical encounters. Inpatient location was measured from each person's home postcode, and stratified by socio-economic disadvantage.
  
  
  RESULTS
  This study covered July - December 2009 with data from 10,064 patients. People from the highest SEIFA group (least disadvantaged) were significantly less likely to be referred to a specialist palliative care service, likely to be referred closer to death and to have more episodes of inpatient care for longer time. Physical proximity of a person's home to inpatient care showed a gradient with increasing distance by decreasing levels of socio-economic advantage.
  
  
  CONCLUSIONS
  These data suggest that a simple relationship of low socioeconomic status and poor access to a referral-based specialty such as palliative care does not exist. Different patterns of referral and hence different patterns of care emerge.
authors.affiliation: Discipline, Palliative and Supportive Services, Flinders University, 700 Goodwood Rd, Daw Park, South Australia, 5041, Australia. david.currow@flinders.edu.au
authors.forename: David C
authors.initials: DC
authors.lastname: Currow
authors.forename: Samuel
authors.initials: S
authors.lastname: Allingham
authors.forename: Sonia
authors.initials: S
authors.lastname: Bird
authors.forename: Patsy
authors.initials: P
authors.lastname: Yates
authors.forename: Joanne
authors.initials: J
authors.lastname: Lewis
authors.forename: James
authors.initials: J
authors.lastname: Dawber
authors.forename: Kathy
authors.initials: K
authors.lastname: Eagar
mesh_terms: D000368:Aged; D001315:Australia; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000191:economics* / Q000706:statistics & numerical data; D011204:Poverty Areas; D012017:Referral and Consultation / Q000191:economics* / Q000706:statistics & numerical data; D012923:Social Class; D012959:Socioeconomic Factors; D062206:Spatial Analysis