Effects of a 24/7 Palliative Care Service Integration in a Metropolitan Area on Non-oncologic Patients

Study Overview
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Brief Summary
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This retrospective observational pre-post study aims to test the effects of introducing a remote telephonic consultation availability from the Palliative Care Service for a cohort of non-oncologic patients followed by the same service, their relatives, and the Emergency Medical Services (EMS) and family care physicians taking care of them. The main question[s] it aims to answer are: Does the introduction of a remote telephonic consultation availability affect the rate of ED access of non-oncologic Palliative-care followed patients during their last 90 days of life? Does the introduction of a remote telephonic consultation availability have an effect on the rate of EMS requests for these patients during their last 90 days of life? Which are the main topics of the calls to the Palliative Care Service? Due to the emergence of COVID-19 pandemic during the study period, a parallel cohort of oncologic patients under 24/7 palliative care by the same service during both the observation periods will be used as reference. Participants will be followed up from the date of taking-over request to the Palliative Care Service to their death or the end of the period of observation if followup began during their last 90 days of life. Otherwise, for those being already under home palliative care at the 90th day before their death, follow up will begin at that day. Researchers will compare two time periods to see if the introduction of a remote telephonic consultation availability has an effect on the supra-mentioned aims.

Official Title
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Effects of a 24/7 Palliative Care Service Integration in a Metropolitan Area on Non-oncologic Patients

Conditions
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Palliative Medicine, Hospice and Palliative Care Nursing, Palliative Care

Intervention / Treatment
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* Other: 24/7 Telephonic Palliative Care Service availability


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients followed by the Metropolitan Palliative Care Service of Bologna Residency in Bologna Metropolitan city Exclusion Criteria: Incomplete data Residency outside Bologna Metropolitan City

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| 2018-19 - Oncologic patients under home palliative care<br>Oncologic patients took over from the Metropolitan Palliative Care Service and receiving home palliative care within their last 90 days of life between 1/1/2018 and 31/12/2019 | Other: 24/7 Telephonic Palliative Care Service availability<br>* Metropolitan Palliative Care Service-implemented 24/7 telephonic availability service for the patients, their relatives, the EMS and Primary Care physicians taking care of them. After consultation, if the information and medical suggestions are not sufficient, an urgent ambulatory or home visit could be planned.<br>|
| 2018-19 - Non-oncologic patients under home palliative care<br>Non-oncologic patients took over from the Metropolitan Palliative Care Service and receiving home palliative care within their last 90 days of life between 1/1/2018 and 31/12/2019 | |
| 2021-2022 - Oncologic patients under home palliative care<br>Oncologic patients took over from the Metropolitan Palliative Care Service and receiving home palliative care within their last 90 days of life between 1/1/2021 and 31/12/2022 | Other: 24/7 Telephonic Palliative Care Service availability<br>* Metropolitan Palliative Care Service-implemented 24/7 telephonic availability service for the patients, their relatives, the EMS and Primary Care physicians taking care of them. After consultation, if the information and medical suggestions are not sufficient, an urgent ambulatory or home visit could be planned.<br>|
| 2021-2022 - Non-Oncologic patients under home palliative care<br>Non-oncologic patients took over from the Metropolitan Palliative Care Service and receiving home palliative care within their last 90 days of life between 1/1/2021 and 31/12/2022 | Other: 24/7 Telephonic Palliative Care Service availability<br>* Metropolitan Palliative Care Service-implemented 24/7 telephonic availability service for the patients, their relatives, the EMS and Primary Care physicians taking care of them. After consultation, if the information and medical suggestions are not sufficient, an urgent ambulatory or home visit could be planned.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Emergency Department Admission rate of patients followed by the Palliative Care Service |  | 48 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| EMS calls rate from patients followed by the Palliative Care Service |  | 48 months | 
| Main topics of the calls received from the Palliative Care Service after the full implementation of a 24/7 service | Classification of the topics of the calls into 5 main classes: Clinical questions, Caregiver Support, Definition of care pathway, Palliative sedation, Other communications. The relative frequency of each main topic will be reported | 24 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Medicine, Palliative, Palliative Care, Hospice and Palliative Care Nursing