Evaluation of the Needs for Palliative Care in Madeira Island: A Pre-pandemic Overview

Abstract

Introduction As general practitioners/family physicians, it is our duty to promote health and prevent disease by providing cure, care, or palliation. Palliative care (PC) plays a crucial role in integrated and patient-centered health services. In the Autonomous Region of Madeira (RAM), Portugal, the PC Unit (PCU) was established in 2012. According to data from 2010, 41.2% of individuals who passed away in this region had a requirement for PC. Our objective is to determine the potential needs for PC in our population in the year 2019, prior to the pandemic. Additionally, we aim to determine the main indications for PC and the number of emergency department admissions/hospitalizations and compare these needs with data from 2010. Methods We conducted an observational, cross-sectional, and descriptive, analytical study, in which the target population consisted of all individuals who passed away in RAM in the year 2019. From this population, a representative sample of deceased individuals was obtained. The gender, age, disease with a potential indication for palliative care, admissions to emergency care and hospitalizations in the preceding 12 months, and county of residence were obtained from the RAM Health Services and analyzed using Microsoft Excel (Microsoft Corp., Redmond, WA, USA) and the Statistical Package for the Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY, USA) software. Results From the total number of individuals who passed away in RAM in the year 2019 (N=2,840), a representative sample of 339 deceased individuals was obtained. Of the deceased individuals, 56% presented with potential indications for palliative care, compared to the 41.2% result recorded in 2010 (p<0.0001). Among these individuals, 51.9% were female, and the average age was 79.7±12.2 years. Neoplasms were the primary indication for palliative care, accounting for 22.7%. Individuals with potential indications for PC, when compared to those without indications, had a higher number of hospitalizations and emergency episodes in the preceding 12 months (p=0.0005 and p=0.008, respectively). Conclusion We conclude that over half of the patients who passed away in RAM had potential indications for palliative care. These individuals experienced a higher number of hospitalizations and emergency episodes in the preceding 12 months. In this study, we also observed a significant increase in the need for palliative care compared to the year 2010.

Keywords: chronic disease; family medicine; multidisciplinary care; needs evaluation; palliative care.