Trends in Health-Care Utilization at the End of Life Among Patients With Hematologic Malignancies in a Middle-Income Country: Challenges and Opportunities in Brazil
| Autor: | Luiz Guilherme L Soares, André M. Japiassú, Renato Vieira Gomes |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Palliative care medicine.medical_treatment law.invention 03 medical and health sciences 0302 clinical medicine Sex Factors law medicine Humans 030212 general & internal medicine Renal replacement therapy Aged Retrospective Studies Aged 80 and over Terminal Care Inpatient care business.industry Medical record Palliative Care Retrospective cohort study General Medicine Emergency department Middle Aged Patient Acceptance of Health Care Intensive care unit Hospitalization Hospice Care 030220 oncology & carcinogenesis Hematologic Neoplasms Health Resources Female business End-of-life care Brazil |
| Zdroj: | The American journal of hospicepalliative care. 36(9) |
| ISSN: | 1938-2715 |
| Popis: | Patients with hematologic malignancies (HMs) often receive poor-quality end-of-life care. This study aimed to identify trends in end-of-life care among patients with HM in Brazil. We conducted a retrospective cohort study (2015-2018) of patients who died with HM, using electronic medical records linked to health insurance databank, to evaluate outcomes consistent with health-care resource utilization at the end of life. Among 111 patients with HM, in the last 30 days of life, we found high rates of emergency department visits (67%, n = 75), intensive care unit admissions (56%, n = 62), acute renal replacement therapy (10%, n = 11), blood transfusions (45%, n = 50), and medical imaging utilization (59%, n = 66). Patients received an average of 13 days of inpatient care and the majority of them died in the hospital (53%, n = 58). We also found that almost 40% of patients (38%, n = 42) used chemotherapy in the last 14 days of life. These patients were more likely to be male (64% vs 22%; P < .001), to receive blood transfusions (57% vs 38%; P = .05), and to die in the hospital (76% vs 39%; P = .009) than patients who did not use chemotherapy in the last 14 days of life. This study suggests that patients with HM have high rates of health-care utilization at the end of life in Brazil. Patients who used chemotherapy in the last 14 days of life were more likely to receive blood transfusions and to die in the hospital. |
| Databáze: | OpenAIRE |
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