title: Reducing avoidable admissions in rural community palliative care: a pilot study of care coordination by General Practice registrars.
abstract: OBJECTIVE
  To investigate the feasibility of using a General Practice registrar (GPR) to coordinate rural palliative care services.
  
  
  METHODS
  A quasi-experimental design was used. Intervention group participants received the GPR service, which involved liaison among the patient, family, General Practitioner, specialist palliative care team and community nurses. Specified risk assessment, care planning and continuity of care were provided. Patients in the comparison group received the standard service.
  
  
  METHODS
  Rural community palliative care.
  
  
  METHODS
  One hundred and ninety-one rural community palliative care patients (99 intervention and 92 control patients).
  
  
  METHODS
  Hospital admissions per 100 patient-days, bed-days per 100 patient-days and proportion of deaths at home.
  
  
  RESULTS
  Patients receiving standard care were twice as likely to spend ≥8 bed-days in hospital (OR 2.09 (95%CI 1.10-3.97); P = 0.02) and were more likely to have ≥ 2 admissions to hospital (OR 3.37 (95%CI 1.83-6.21); P < 0.001), per 100 patient-days than the intervention group after adjusting for diagnosis group (cancer or not) and residence in residential aged care. Controls were significantly less likely to die at home than the intervention group (OR 0.41 (95%CI 0.20-0.86); P = 0.02).
  
  
  CONCLUSIONS
  This is a small proof of concept pilot study limited by lack of randomisation. The results demonstrate the feasibility of using a GPR to manage continuity of care for rural community palliative care patients. Given the potential confounding factors, further investigation via a larger randomised trial is required.
authors.affiliation: School of Nursing & Midwifery, Griffith University, Southport, Queensland, Australia.|School of Health and Human Sciences, Southern Cross University, Lismore, New South Wales, Australia.
authors.forename: Thea F
authors.initials: TF
authors.lastname: van de Mortel
authors.affiliation: Northern NSW Local Health District, Lismore, New South Wales, Australia.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Marr
authors.affiliation: Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Burmeister
authors.affiliation: North Coast GP Training, Ballina, New South Wales, Australia.
authors.forename: Hilton
authors.initials: H
authors.lastname: Koppe
authors.affiliation: North Coast GP Training, Ballina, New South Wales, Australia.
authors.forename: Christine
authors.initials: C
authors.lastname: Ahern
authors.affiliation: Tintenbar Medical Centre, Tintenbar, New South Wales, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Walsh
authors.affiliation: North Coast GP Training, Ballina, New South Wales, Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: Tyler-Freer
authors.affiliation: North Coast Primary Health Network, Ballina, New South Wales, Australia.|School of Medicine, Sydney University, Sydney, New South Wales, Australia.
authors.forename: Dan
authors.initials: D
authors.lastname: Ewald
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005240:Feasibility Studies; D005260:Female; D058005:General Practitioners; D006699:Home Care Services / Q000458:organization & administration*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010865:Pilot Projects; D000075082:Proof of Concept Study; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population
keywords: General Practice Registrar; care coordination; community palliative care; home deaths; hospital admissions