Letters
Hospital and emergency
department use in the last
year of life: a baseline for
future modifications to
end-of-life care
TO THE EDITOR : The research by
Rosenwax and colleagues1 and
Lowthian and colleagues2 published
in the Journal highlights the need for
increased capacity in end-of-life care
within primary care to reduce the
inappropriate use of acute health
care services at the end of life.
Providing high-quality care for
people diagnosed with advanced
chronic conditions is among the
most complex challenges for general
practitioners.3 GPs and other
primary care providers are able to
provide appropriate palliative and
end-of-life care when they are well
supported by relevant specialists.3
For patients to be well cared for in
the community, it is also necessary
for informal carers to have the
strength, the will and the skill to
provide such care, as well as timely
access to support and medical care.
The recent National Health and
Hospitals Reform Commission’s
report4 and the Australian
Government’s National Primary
Health Care Strategy5 both recognise
the need to build “the capacity and
competence of primary health care
services” 4 to support their dying
patients. These documents make
recommendations that begin to
address the current difficulties of
caring for these patients in the
community. Of significance are
recommendations for increased
support for carers; improved
shared-care arrangements; and
better access to specialist palliative
care, support and funding for
advance care planning and improved
access to primary health care
professionals.4 This includes a
commitment to address workforce
shortages and improving out-of-
hours access to medical care.5
Such recommendations are
positive and will be helpful when
they are fully realised. However,
issues within primary care — both at
the community and individual
general practice levels — also need
to be addressed. People for whom a
palliative approach is appropriate
3 Mitchell GK. How well do general practitioners
deliver palliative care? A systematic review. Palliat
Med 2002; 16: 457-464.
4 National Health and Hospitals Reform
Commission. A healthier future for all Australians:
final report June 2009. Canberra: Department of
Health and Ageing, 2009. http://www.
health.gov.au/internet/nhhrc/publishing.nsf/
Content/1AFDEAF1FB76A1D8CA2576
00000B5BE2/$File/Final_Report_of_
the%20nhhrc_June_2009.pdf (accessed Jul 2011).
5 Australian Government Department of Health and
Ageing. Building a 21st century primary health care
system: Australia’s first National Primary Health
Care Strategy. Canberra: DoHA, 2010. http://
www.yourhealth.gov.au/internet/yourhealth/
publishing.nsf/Content/CA2575FD004C0485C
A257729001BACBD/$File/6552%20NPHC%2
01205.pdf (accessed Jul 2011). ❏
need to be systematically and
proactively identified in a timely
way. Needs assessment and care
planning should be undertaken to
ensure that problems and
preferences for care are identified
and mechanisms are put in place to
support such care.
To promote optimal end-of-life
care, a coordinated, multidisciplinary
approach is as important in the
community as it is in the hospital
setting. Good communication and
collaboration between primary care
providers, the patient’s specialists
and specialist palliative care
providers are imperative. Also
essential is an ongoing dialogue with
the patient and family to enable a
clear understanding of the goals of
treatment and to proactively plan for
likely adverse events. Routinely
planning for likely scenarios will
potentially reduce the use of acute
services and encourage the provision
of care in more appropriate
environments.
Claire E Johnson Research Fellow, Cancer and
Palliative Care Research and Evaluation Unit1
Geoffrey K Mitchell Professor of General Practice
and Palliative Care2
1 University of Western Australia, Perth, WA.
2 University of Queensland, Brisbane, QLD.
Claire.johnson@uwa.edu.au
Competing interests: No relevant disclosures.
doi: 10.5694/mja11.10714
1 Rosenwax LK, McNamara BA, Murray K, et al.
Hospital and emergency department use in the
last year of life: a baseline for future modifications
to end-of-life care. Med J Aust 2011; 194: 570-573.
2 Lowthian JA, Jolley DJ, Curtis AJ, et al. The
challenges of population ageing: accelerating
demand for emergency ambulance services by
older patients, 1995–2015. Med J Aust 2011; 194:
574-578.
MJA 195 (5) · 5 September 2011 267