Fewer than 1 in 5 Ontarians receive doctor house calls or palliative home care in their last year of life

Posted on Thursday, February 15, 2018

Man wearing a hospital gown shown using a walker

 

Most Ontarians want to die at home, but despite this nearly 70 per cent die in hospitals or long-term care facilities. A new study from the Institute for Clinical Evaluative Sciences (ICES) shows end-of-life care like doctor house calls or in-home palliative care could reduce the chance of dying in hospital by about 50 per cent.

“Our research has shown that end-of-life care in a patients’ home can dramatically reduce the risk of dying in hospital,” says Dr. Peter Tanuseputro, the lead author of the study, adjunct scientist at ICES, researcher at the Bruyère Research Institute, a staff physician at division of palliative care at The Ottawa Hospital and assistant professor at the University of Ottawa.

The study published today in PLOS ONE is the largest of its kind to show the effect of doctor home visits on where people die. Using secure patient health records housed at ICES, the researchers looked at 264,755 Ontario decedents from April 1, 2010 to March 31, 2013 and found receiving doctor house calls for end-of-life care reduces the chance of dying in hospital by about 50 per cent and receiving palliative home care also reduces the chance of dying in hospital by about 50 per cent.

“Most people would be able to die at home if they had the supports in place to make that happen. Unfortunately in most areas across Canada, it’s quite arbitrary who gets palliative care in the home, depending on factors like if your family doctor does home visits, what neighborhood you live in, and what you’re dying of. Canada remains in the back of the pack in developed nations in terms of the percentage who die in hospital,” says Tanuseputro.

The researchers found less than one in five Ontarians receive doctor house calls or palliative home care in their last year of life.

“Our research points to the need for a structured palliative care strategy across the province to ensure people have a choice of dying in their homes, and not in hospitals, if they wish. As it stands now, who can access home palliative care really varies across Ontario,” adds Tanuseputro.

About 38 per cent of physicians in Ontario deliver palliative care, and only a small minority of those doctors provides home visits. Only one in five palliative care encounters happen in patients’ homes.

Tanuseputro points to other studies that his group has done that show patients with certain diagnoses, like cancer, and those who live in wealthier neighbourhoods have a much higher chance of getting a home visit.

Associations between physician home visits for dying and place of death: a population-based retrospective cohort study” was published today in the journal PLOS ONE.

Author block: Peter Tanuseputro, Sarah Beach, Mathieu Chalifoux, Walter P Wodchis, Amy T. Hsu, Hsien Seow and Douglas G Manuel.

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