Seguimiento proactivo por los equipos de Atención Primaria en los pacientes con necesidades paliativas en domicilio: ¿puede condicionar el lugar de fallecimiento?

Abstract

Objective

To evaluate whether proactive follow-up by Primary Care teams for patients attended by Home Palliative Care Support Teams influences the place of death for patients with advanced chronic illness. Additionally, to examine whether this association is affected by the patient's complexity.

Material and methods

An analytical, observational, retrospective cohort study was conducted involving 422 patients attended by a home palliative care support team in Madrid in 2023. Variables included sociodemographic and clinical data, resource consumption, and preferences regarding the place of death. Bivariate and multivariate logistic regressions were used to identify factors associated with the place of death (home or outside: hospital or palliative care unit).

Results

While 63% of patients expressed a preference to die at home, only 32.7% did so. Personal and family preferences emerged as the most decisive factors determining the place of death. Proactive follow-up was associated with a lower likelihood of dying at home after adjusting for family preferences, patient complexity, and functionality (Odds ratio: 0.26; 95% confidence interval: 0.11-0.59). Patients with non-oncological conditions and low scores in functionality indices were more likely to die at home.

Conclusions

Joint follow-up between Primary Care and home palliative care support team increases the probability of dying outside the home, contrary to what is reported in the literature. However, this association may reflect the inability to provide adequate home care rather than being the cause of the place of death.