Can comprehensive specialised end-of-life care be provided at home? Lessons from a study of an innovative consultant-led community service in the UK

The Midhurst Macmillan Specialist Palliative Care Service (MMSPCS) is a UK, medical consultant‐led, multidisciplinary team aiming to provide round‐the‐clock advice and care, including specialist interventions, in the home, community hospitals and care homes. Of 389 referrals in 2010/11, about 85% we...

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Published in:	European journal of cancer care Vol. 24; no. 2; pp. 253 - 266
Main Authors:	Noble, B., King, N., Woolmore, A., Hughes, P., Winslow, M., Melvin, J., Brooks, J., Bravington, A., Ingleton, C., Bath, P.A.
Format:	Journal Article
Language:	English
Published:	England Blackwell Publishing Ltd 01-03-2015 Hindawi Limited BlackWell Publishing Ltd
Subjects:	Adult Aged Attitude of Health Personnel Caregivers Community Health Services end-of-life care Female Health Care Costs home care services Home Care Services - economics Home Care Services - organization & administration Home Care Services - standards home death Hospice Care - organization & administration Hospitals Humans Male Middle Aged mixed methods evaluation Neoplasms - therapy Nursing Older people Original Palliative care Palliative Care - economics Palliative Care - organization & administration Palliative Care - standards Patient Satisfaction preferred place of care/death Retrospective Studies specialist palliative care Terminal Care - economics Terminal Care - organization & administration Terminal Care - standards United Kingdom United Kingdom > UK England home death mixed methods evaluation home care services specialist palliative care end-of-life care preferred place of care/death
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Summary:	The Midhurst Macmillan Specialist Palliative Care Service (MMSPCS) is a UK, medical consultant‐led, multidisciplinary team aiming to provide round‐the‐clock advice and care, including specialist interventions, in the home, community hospitals and care homes. Of 389 referrals in 2010/11, about 85% were for cancer, from a population of about 155 000. Using a mixed method approach, the evaluation comprised: a retrospective analysis of secondary‐care use in the last year of life; financial evaluation of the MMSPCS using an Activity Based Costing approach; qualitative interviews with patients, carers, health and social care staff and MMSPCS staff and volunteers; a postal survey of General Practices; and a postal survey of bereaved caregivers using the MMSPCS. The mean cost is about 3000 GBP (3461 EUR) per patient with mean cost of interventions for cancer patients in the last year of life 1900 GBP (2192 EUR). Post‐referral, overall costs to the system are similar for MMSPCS and hospice‐led models; however, earlier referral avoided around 20% of total costs in the last year of life. Patients and carers reported positive experiences of support, linked to the flexible way the service worked. Seventy‐one per cent of patients died at home. This model may have application elsewhere.
Bibliography:	ark:/67375/WNG-N86BGC7L-P istex:8D155422353AB656957636851AAC6A83D0F132F1 ArticleID:ECC12195 Macmillan Cancer Support ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1 The study was funded by Macmillan Cancer Support. Noble B., King N., Woolmore A., Hughes P., Winslow M., Melvin J., Brooks J., Bravington A., Ingleton C. & Bath P.A. (2015)
ISSN:	0961-5423 1365-2354
DOI:	10.1111/ecc.12195