94 000 deaths in Ontario 2014/2015

Universal insured hospital and physician system

No restrictions on curative along with PC

No written document required to initiate PC, though often the ‘surprise question’ of expected death of 1 year to 6 months is used to initiate care47

Provided by general practitioners, specialists and home-care providers

548 000 deaths 2015

Primary care delivered heavily by general practitioners and primary care trusts

Universal health insurance

Patients may be terminal (expected to die within 12 months, have a life-limiting illness or chronic condition with a trajectory that has a sharp functional decline or extensive acute episodes, or require extended care)

Can mix palliative and curative care34

2.6 M deaths in 2015

Hospice benefit includes visiting interprofessional providers in home, residential hospices, hospitals, long-term care, etc

Available to Medicare patients

Must have signed physician note stating expected death within 6 months

Must waive access to curative treatments to access hospice benefit32

23 852 deaths in Western Australia in 2009/2010

Mix of private and government service providers

Use ‘normative need’ to assess access to PC specialists33

2.2 physicians/1000 ppl (2015)

47%/53%: generalists/specialists37

2.8 physicians/1000 ppl (2015)

29%/71%: generalists/specialists37

2.5 physicians/1000 ppl (2011)

12%/88%: generalists/specialists37

3.5 physicians/1000 ppl (2015)

45%/47%: generalists/specialists (8%: medical doctors not further defined)37

54% of decedents between 2010 and 2012 received at least PC services (from billing claims) in any setting.(table 2)

74% of people who are in need of PC receive either specialist or generalist services

18% of non-malignant access to PC was for chronic respiratory illness, 11% for heart failure34

46% of Medicare (>65 years old) decedents received ≥1 day of hospice care (via the Medicare hospice benefit) in 201532

46% of decedents received any PC33

88% of terminal illness, 44% of organ failure and 32% of frailty decedents (or 39% non-cancer) received any PC services (table 2)

Among those receiving any PC services, 55% died from terminal illness, 27% from organ failure and 18% from frailty illness trajectories

88% of PC inpatients have cancer diagnosis

20% of inpatient referrals are for non-cancer34

Among those who received the hospice benefit, the principal diagnoses were: 27% cancer, 19% cardiac, 17% dementia and 11% respiratory32

69% of patients with cancer had access to specialist care

14% of patients without cancer had access to specialists33

Terminal illness 107 days

Organ failure 22 days

Frailty 24 days (table 2)

37 days for cancer

16 days for non-cancer48

Cancer: 47/(19) days

cardiac: 76/(28) days

dementia: 105/(56) days

respiratory 69/(19) days

stroke 77/(20) days32

Median number of days receiving specialist PC was 30 (cancer), 8 (COPD) and 5 (Alzheimers and heart failure)33

Median days PC initiated before death: 62 (cancer), 6 (Alzheimers) and 43 (COPD)33

68% of cancer decedents have PC in a community setting

76% in an acute care setting

<1% of PC for any trajectory was received in an LTC facility (table 2)

~20% of LTC residents were seen by a PC specialist nurse, 96% were seen by a GP

Poor access to hospitals. Only 21% of hospitals provide face-to-face PC 24/7

27% of hospital outpatient PC and 17% of community PC provided to non-malignant disease34

Home 56.0%

Nursing facility 41.3%

Hospice inpatient facility 1.3%

Acute care hospital 0.5%

Other 0.9%32

Organ failure patients (eg, liver failure) tended to receive care in hospital over community settings

Motor neuron and cancer decedents had increased access to community services33