FACTORS ASSOCIATED WITH UTILIZATION OF SPECIALIST PALLIATIVE CARE SERVICES - A POPULATION-BASED STUDY

Background Palliative care services have been criticized for providing specialist care for a privileged few but there is no routinely availa ble information to prove or refute these criticisms. Our survey aimed to identify and describe the patients using specialist palliative care services in a Health District and identify whether any factors distin guished them from other eligible patients who did not use these servic es. Methods Clinical and demographic data were collected retrospective ly for all residents of the Health District who died of cancer during 1991, Comparisons were made between those who used specialist palliati ve care services and those who did not. Results A total of 521 cases w ere studied of which 157 (30 per cent) had used the specialist palliat ive care services. These cases (Group 1) compared with the remainder ( Group 2) were statistically significantly (p < 0.05) different in term s of their age at death (mean age for Group 1 was 66.6 years, compared with 73 years for Group 2), survival times from diagnosis (median num ber of days for Group 1 was 242, compared with 110 days for Group 2) a nd general practitioner practice, There were no significant difference s between the two groups for all other variables, i.e. ward of residen ce, social class, cancer site and gender. Cases in Group 1 were more l ikely to die at home (39 per cent compared with 27 per cent in Group 2 ). Conclusions Effectiveness studies in the field of palliative care a re essential but difficult. We suggest that there is an important plac e for local studies of needs and utilization for guiding sensitive con tracting.