A NEW HOME-BASED PALLIATIVE CARE PROGRAM ENABLE EARLY PALLIATIVE 2023 - เยือนเย็น วิสาหกิจเพื่อสังคม

A NEW HOME-BASED PALLIATIVE CARE PROGRAM ENABLE EARLY PALLIATIVE 2023 Issarang Nuchprayoon Bangkok 10330, Thailand CARE ACCESS AND HOME DEATHS IN BANGKOK METROPOLITAN REGION.

Introduction

Palliative care (PC) is an unmet need in Bangkok metropolitan region. In-hospital referral to palliative physicians are often late. Many elderly Thai patients want palliative care but refuse to visit the hospitals. Yuenyen Social Enterprise (SE) is a new home-based PC service organization since 2018. Yuenyen SE is a lean start-up, physician-led, philantrophic organization that works independently of hospitals. Yuenyen SE accepts patient’s self-referral, does not require physician referral, conducts independent counseling and advance care planning at home, and provide continuity of PC service exclusively at home until death. The primary focus of the work is to empower families to gain confidence in taking care of patienst at home, fulfilling the patient’s quality of life, and provide intensive symptom control at home to obviate the need for hospital care.

Methods

All patients who registered with Yuenyen SE since inception the program and received counseling at home were prospectively followed until death. Survival time were estimated using Kaplan-Meier method

Results

During the first 5-year of operation, Yuenyen SE has provided home PC to 855 patients, with an annual growth of 80% every year. Families were referred the SE mostly by word-of-mouth and by social media. Around two-thirds (N=545) were advanced cancer patients with a median age of 66 years and the rest were elderly in various state of health, from well centenarians to bed-ridden patients with complex medical conditions, with a median age of 86 years. The overall median survival of the entire cohort is 7.1 weeks (mean, 5.7 months). Of 643 patients who have died, 473 (73.6%) died peacefully at home, 8 (1.2%) in a nursing home, 16 (2.5%) at a hospice or hospice ward, 90 (14%) at a local hospital, and 56 (8.7%) at a tertiary-care hospital. After registering to the Yuenyen PC service, most patients (70%) have no further hospital admissions, thereby reducing terminal health care untilization significantly.