title: The nature of, and reasons for, 'inappropriate' hospitalisations among patients with palliative care needs: a qualitative exploration of the views of generalist palliative care providers.
abstract: BACKGROUND
  Recent studies have concluded that there is significant potential to reduce the extent of 'inappropriate' hospitalisations among patients with palliative care needs. However, the nature of, and reasons for, inappropriate hospitalisations within a palliative care context is under-explored.
  
  
  OBJECTIVE
  To explore the opinions of 'generalist' palliative care providers regarding the nature of, and reasons for, inappropriate admissions among hospital inpatients with palliative care needs.
  
  
  METHODS
  Qualitative study with data collected via individual interviews and focus groups.
  
  
  METHODS
  Participants (n = 41) comprised 'generalist' palliative care providers working in acute hospital and community settings.
  
  
  METHODS
  One District Health Board in an urban area of New Zealand.
  
  
  RESULTS
  The majority of participants discussed 'appropriateness' in relation to their own understanding of a good death, which typically involved care being delivered in a 'homely' environment, from known people. Differing attitudes among cultural groups were also evident. The following reasons for inappropriate admissions were identified: family carers being unable to cope, the 'rescue culture' of modern medicine, the financing and availability of community services and practice within aged residential care.
  
  
  CONCLUSIONS
  On the basis of our findings, we recommend a shift to the term 'potentially avoidable' admission rather than 'inappropriate admission'. We also identify an urgent need for debate regarding the role of the acute hospital within a palliative care context. Interventions to reduce hospital admissions within this population must target societal understandings of death and dying within the context of medicalisation, as well as take into account cultural and ethnic diversity in attitudes, if they are to be successful.
authors.affiliation: School of Nursing, University of Auckland, Auckland, New Zealand. m.gott@auckland.ac.nz
authors.forename: Merryn
authors.initials: M
authors.lastname: Gott
authors.forename: Rosemary
authors.initials: R
authors.lastname: Frey
authors.forename: Jackie
authors.initials: J
authors.lastname: Robinson
authors.forename: Michal
authors.initials: M
authors.lastname: Boyd
authors.forename: Anne
authors.initials: A
authors.lastname: O'Callaghan
authors.forename: Naomi
authors.initials: N
authors.lastname: Richards
authors.forename: Barry
authors.initials: B
authors.lastname: Snow
mesh_terms: D001291:Attitude of Health Personnel; D003469:Culture; D017144:Focus Groups; D006300:Health Services Misuse / Q000517:prevention & control; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D009520:New Zealand; D010166:Palliative Care / Q000458:organization & administration*; D010343:Patient Admission / Q000706:statistics & numerical data; D036301:Qualitative Research
keywords: Hospitalisation; culture; hospitals; palliative care; terminal care