title: Prevalence and characteristics of patients with advanced chronic conditions in need of palliative care in the general population: a cross-sectional study.
abstract: BACKGROUND
  Of deaths in high-income countries, 75% are caused by progressive advanced chronic conditions. Palliative care needs to be extended from terminal cancer to these patients. However, direct measurement of the prevalence of people in need of palliative care in the population has not been attempted.
  
  
  OBJECTIVE
  Determine, by direct measurement, the prevalence of people in need of palliative care among advanced chronically ill patients in a whole geographic population.
  
  
  METHODS
  Cross-sectional, population-based study.
  
  
  METHODS
  prevalence of advanced chronically ill patients in need of palliative care according to the NECPAL CCOMS-ICO(©) tool. NECPAL+ patients were considered as in need of palliative care.
  
  
  METHODS
  County of Osona, Catalonia, Spain (156,807 inhabitants, 21.4% > 65 years). Three randomly selected primary care centres (51,595 inhabitants, 32.9% of County's population) and one district general hospital, one social-health centre and four nursing homes serving the patients. Subjects were all patients attending participating settings between November 2010 and October 2011.
  
  
  RESULTS
  A total of 785 patients (1.5% of study population) were NECPAL+: mean age = 81.4 years; 61.4% female. Main disease/condition: 31.3% advanced frailty, 23.4% dementia, 12.9% cancer (ratio of cancer/non-cancer = 1/7), 66.8% living at home and 19.7% in nursing home; only 15.5% previously identified as requiring palliative care; general clinical indicators of severity and progression present in 94% of cases.
  
  
  CONCLUSIONS
  Direct measurement of prevalence of palliative care needs on a population basis is feasible. Early identification and prevalence determination of these patients is likely to be the cornerstone of palliative care public health policies.
authors.affiliation: 1The Qualy Observatory/WHO Collaborating Centre for Palliative Care Public Health Programmes (WHOCC), Institut Català d'Oncologia (ICO), Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Gómez-Batiste
authors.forename: Marisa
authors.initials: M
authors.lastname: Martínez-Muñoz
authors.forename: Carles
authors.initials: C
authors.lastname: Blay
authors.forename: Jordi
authors.initials: J
authors.lastname: Amblàs
authors.forename: Laura
authors.initials: L
authors.lastname: Vila
authors.forename: Xavier
authors.initials: X
authors.lastname: Costa
authors.forename: Joan
authors.initials: J
authors.lastname: Espaulella
authors.forename: Jose
authors.initials: J
authors.lastname: Espinosa
authors.forename: Carles
authors.initials: C
authors.lastname: Constante
authors.forename: Geoffrey K
authors.initials: GK
authors.lastname: Mitchell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000706:statistics & numerical data*; D013030:Spain / Q000453:epidemiology
keywords: Palliative care; chronic disease; frail elderly; health planning; prevalence; public health