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Interactions with the healthcare system influence advance care planning activities: results from a representative survey in 11 developed countries.
Fam Pract. 2018 05 23; 35(3):307-311.FP

Abstract

Aim

To identify factors associated with completion of Advance Care Planning (ACP) by patients seen in primary care in developed countries. We hypothesized that the quality of primary care is associated.

Method

We analysed respondent reported individual and healthcare utilization factors associated with the completion of ACP activities from the 2014 Commonwealth Fund International Health Policy Survey of Older Adults in 11 Countries. The primary outcome is the combined number of ACP activities completed. ACP activities included discussion of treatment preferences, documentation of healthcare wishes, or documentation of a surrogate decision maker. A quality of primary care index was calculated.

Results

Respondents averaged 69 years old. Most were women, graduated high school, rated their income as average or higher, and rated their health as good or better. A minority reported multimorbidity, accessed the emergency department or hospital, or were informal caregivers. Out of 25530 survey respondents, 13409 (53%) reported completion of any ACP activity; 11579 (45%) had discussed treatment preferences. Generalized linear mixed model results suggest that hospitalization (rate ratio [RR] 1.18), multimorbidity (RR 1.16), informal caregiving (RR 1.13), higher education level (RR 1.14), income (RR 1.05), access to higher quality primary care (RR 1.04) and ED visits (RR 1.04) were associated with higher rates of ACP activities. Male gender (RR 0.85) and higher perceived health status (RR 0.96) were associated with lower rates.

Conclusions

In this international study, individuals with greater interaction with the healthcare system through hospitalization, multimorbidity, access to quality primary care and informal caregiving reported more ACP activities.

Authors+Show Affiliations

University of Colorado School of Medicine, Aurora, CO, USA.University of Colorado School of Medicine, Aurora, CO, USA.University of Colorado School of Medicine, Aurora, CO, USA.University of Colorado School of Medicine, Aurora, CO, USA. Colorado School of Public Health, Aurora, CO, USA.University of Colorado School of Medicine, Aurora, CO, USA. Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA.University of Colorado School of Medicine, Aurora, CO, USA.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29140508

Citation

Sable-Smith, Alex, et al. "Interactions With the Healthcare System Influence Advance Care Planning Activities: Results From a Representative Survey in 11 Developed Countries." Family Practice, vol. 35, no. 3, 2018, pp. 307-311.
Sable-Smith A, Arnett KR, Nowels MA, et al. Interactions with the healthcare system influence advance care planning activities: results from a representative survey in 11 developed countries. Fam Pract. 2018;35(3):307-311.
Sable-Smith, A., Arnett, K. R., Nowels, M. A., Colborn, K., Lum, H. D., & Nowels, D. (2018). Interactions with the healthcare system influence advance care planning activities: results from a representative survey in 11 developed countries. Family Practice, 35(3), 307-311. https://doi.org/10.1093/fampra/cmx113
Sable-Smith A, et al. Interactions With the Healthcare System Influence Advance Care Planning Activities: Results From a Representative Survey in 11 Developed Countries. Fam Pract. 2018 05 23;35(3):307-311. PubMed PMID: 29140508.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Interactions with the healthcare system influence advance care planning activities: results from a representative survey in 11 developed countries. AU - Sable-Smith,Alex, AU - Arnett,Kelly R, AU - Nowels,Molly A, AU - Colborn,Kathryn, AU - Lum,Hillary D, AU - Nowels,David, PY - 2017/11/16/pubmed PY - 2019/3/21/medline PY - 2017/11/16/entrez SP - 307 EP - 311 JF - Family practice JO - Fam Pract VL - 35 IS - 3 N2 - Aim: To identify factors associated with completion of Advance Care Planning (ACP) by patients seen in primary care in developed countries. We hypothesized that the quality of primary care is associated. Method: We analysed respondent reported individual and healthcare utilization factors associated with the completion of ACP activities from the 2014 Commonwealth Fund International Health Policy Survey of Older Adults in 11 Countries. The primary outcome is the combined number of ACP activities completed. ACP activities included discussion of treatment preferences, documentation of healthcare wishes, or documentation of a surrogate decision maker. A quality of primary care index was calculated. Results: Respondents averaged 69 years old. Most were women, graduated high school, rated their income as average or higher, and rated their health as good or better. A minority reported multimorbidity, accessed the emergency department or hospital, or were informal caregivers. Out of 25530 survey respondents, 13409 (53%) reported completion of any ACP activity; 11579 (45%) had discussed treatment preferences. Generalized linear mixed model results suggest that hospitalization (rate ratio [RR] 1.18), multimorbidity (RR 1.16), informal caregiving (RR 1.13), higher education level (RR 1.14), income (RR 1.05), access to higher quality primary care (RR 1.04) and ED visits (RR 1.04) were associated with higher rates of ACP activities. Male gender (RR 0.85) and higher perceived health status (RR 0.96) were associated with lower rates. Conclusions: In this international study, individuals with greater interaction with the healthcare system through hospitalization, multimorbidity, access to quality primary care and informal caregiving reported more ACP activities. SN - 1460-2229 UR - https://www.unboundmedicine.com/medline/citation/29140508/Interactions_with_the_healthcare_system_influence_advance_care_planning_activities:_results_from_a_representative_survey_in_11_developed_countries_ L2 - https://academic.oup.com/fampra/article-lookup/doi/10.1093/fampra/cmx113 DB - PRIME DP - Unbound Medicine ER -