Effect of Primary Care Involvement on End-of-Life Care Outcomes: A Systematic Review

Abstract

Objectives: To investigate the relationship between primary care involvement in end-of-life (EOL) care and health and utilization outcomes.

Design: Systematic review using MEDLINE and Web of Science.

Setting: All English literature published between 1994 and August 31, 2014, that included terms related to primary care providers (PCPs), continuity of care, EOL care, and palliative care.

Participants: Individuals receiving care from a PCP at the end of life.

Measurements: Study design, subject characteristics, study outcomes and results.

Results: Of 2,812 studies screened, 13 were included in this study. The studies were mostly conducted in the United States (n = 5) and Canada (n = 4) and analyzed data collected from 1989 to 2010. Almost all studies used different definitions of PCP involvement in care, but in general, individuals who received more care from PCPs were more likely to be discharged or die with supportive care (home or hospice) than those receiving less PCP care. A few studies indicated that individuals seeing a PCP were less likely to have hospital or emergency department admissions, although the evidence for this was mixed. Studies linking PCP involvement to resource use, symptom management, and survival had mixed results or showed no association.

Conclusion: When PCPs are involved in EOL care, people are more likely to die out of the hospital. Thus, the relationship with the PCP may be particularly important in EOL care, because PCPs may help individual establish goals of care and determine treatment preferences.

Keywords: continuity; end of life; palliative; primary care.