Background: Providing end of life care in rural areas is challenging. We evaluated in a pilot whether nurse\npractitioner (NP)-led care, including clinical care plans negotiated with involved health professionals including the\ngeneral practitioner(GP), Ã?± patient and/or carer, through a single multidisciplinary case conference (SMCC), could\ninfluence patient and health system outcomes.\nMethods: Setting ââ?¬â?? Australian rural district 50 kilometers from the nearest specialist palliative care service.\nParticipants: Adults nearing the end of life from any cause, life expectancy several months. Intervention- NP led\nassessment, then SMCC as soon as possible after referral. A clinical care plan recorded management plans for\ncurrent and anticipated problems and who was responsible for each action. Eligible patients had baseline, 1 and\n3 month patient-reported assessment of function, quality of life, depression and carer stress, and a clinical record\naudit. Interviews with key service providers assessed the utility and feasibility of the service.\nResults: Sixty-two patients were referred to the service, forty from the specialist service. Many patients required\nimmediate treatment, prior to both the planned baseline assessment and the planned SMCC (therefore ineligible\nfor enrollment). Only six patients were assessed per protocol, so we amended the protocol. There were 23 case\nconferences. Reasons for not conducting the case conference included the patient approaching death, or assessed\nas not having immediate problems. Pain (25 %) and depression (23 %) were the most common symptoms\ndiscussed in the case conferences. Ten new advance care plans were initiated, with most patients already having\none. The NP or RN made 101 follow-up visits, 169 phone calls, and made 17 referrals to other health professionals.\nThe NP prescribed 24 new medications and altered the dose in nine. There were 14 hospitalisations in the time\nframe of the project. Participants were satisfied with the service, but the service cost exceeded income from\nnational health insurance alone.\nConclusions: NP-coordinated, GP supported care resulted in prompt initiation of treatment, good follow up, and a\ncare plan where all professionals had named responsibilities. NP coordinated palliative care appears to enable more\nintegrated care and may be effective in reducing hospitalisations.
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