• Markus Krause, Bianka Ditscheid, Thomas Lehmann, Maximiliane Jansky, Ursula Marschall, Winfried Meißner, Friedemann Nauck, Ulrich Wedding, and Antje Freytag.
• Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany.
• Palliat Med. 2021 Jun 1; 35 (6): 1158-1169.

BackgroundComparative effectiveness of different types of palliative homecare is sparsely researched internationally-despite its potential to inform necessary decisions in palliative care infrastructure development. In Germany, specialized palliative homecare delivered by multi-professional teams has increased in recent years and factors beyond medical need seem to drive its involvement and affect the application of primary palliative care, delivered by general practitioners who are supported by nursing services.AimTo compare effectiveness of primary palliative care and specialized palliative homecare in reducing potentially aggressive interventions at the end-of-life in cancer and non-cancer.DesignRetrospective population-based study with claims data from 95,962 deceased adults in Germany in 2016 using multivariable regression analyses.Settings/ParticipantsPatients having received primary palliative care or specialized palliative homecare (alone or in addition to primary palliative care), for at least 14 days before death, differentiating between cancer and non-cancer patients.ResultsRates of potentially aggressive interventions in most indicators were higher in primary palliative care than in specialized palliative homecare (p < 0.01), in both cancer and non-cancer patients: death in hospital (odds ratio (OR) 4.541), hospital care (OR 2.720), intensive care treatment (OR 6.749), chemotherapy (OR 2.173), and application of a percutaneous endoscopic gastrostomy (OR 4.476), but not for parenteral nutrition (OR 0.477).ConclusionSpecialized palliative homecare is more strongly associated with reduction of potentially aggressive interventions than primary palliative care in the last days of life. Future research should identify elements of specialized palliative homecare applicable for more effective primary palliative care, too. German Clinical Trials Register (DRKS00014730).

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