title: Involvement of a Case Manager in Palliative Care Reduces Hospitalisations at the End of Life in Cancer Patients; A Mortality Follow-Back Study in Primary Care.
abstract: BACKGROUND
  Case managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal carers in addition to the care provided by the general practitioner (GP) and home-care nurse.
  
  
  OBJECTIVE
  To compare cancer patients with and without additional support from a case manager on: 1) the patients' general characteristics, 2) characteristics of care and support given by the GP, 3) palliative care outcomes.
  
  
  METHODS
  This article is based on questionnaire data provided by GPs participating in two different studies: the Sentimelc study (280 cancer patients) and the Capalca study (167 cancer patients). The Sentimelc study is a mortality follow-back study amongst a representative sample of GPs that monitors the care provided via GPs to a general population of end-of-life patients. Data from 2011 and 2012 were analysed. The Capalca study is a prospective study investigating the implementation and outcome of the support provided by case managers in primary palliative care. Data were gathered between March 2011 and December 2013.
  
  
  RESULTS
  The GP is more likely to know the preferred place of death (OR 7.06; CI 3.47-14.36), the place of death is more likely to be at the home (OR 2.16; CI 1.33-3.51) and less likely to be the hospital (OR 0.26; CI 0.13-0.52), and there are fewer hospitalisations in the last 30 days of life (none: OR 1.99; CI 1.12-3.56 and one: OR 0.54; CI 0.30-0.96), when cancer patients receive additional support from a case manager compared with patients receiving the standard GP care.
  
  
  CONCLUSIONS
  Involvement of a case manager has added value in addition to palliative care provided by the GP, even though the role of the case manager is 'only' advisory and he or she does not provide hands-on care or prescribe medication.
authors.affiliation: Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands; Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, the Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Annicka G M
authors.initials: AG
authors.lastname: van der Plas
authors.affiliation: Department of Anaesthesiology, Pain, and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: Kris C
authors.initials: KC
authors.lastname: Vissers
authors.affiliation: Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands; Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, the Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands; Nursing Care, NIVEL Netherlands Institute for Health Services Research, Utrecht, the Netherlands.
authors.forename: Anneke L
authors.initials: AL
authors.lastname: Francke
authors.affiliation: NIVEL Primary Care Database, Sentinel Practices, Utrecht, the Netherlands.
authors.forename: Gé A
authors.initials: GA
authors.lastname: Donker
authors.affiliation: Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, the Netherlands; Department of Anaesthesiology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Wim J J
authors.initials: WJ
authors.lastname: Jansen
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussel and Ghent, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.affiliation: Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands; Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, the Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
mesh_terms: D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D009426:Netherlands / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000706:statistics & numerical data*; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000706:statistics & numerical data*