• Paige Comstock Barker, Rebecca Liddicoat Yamarik, Oluwaseun Adeyemi, Allison M Cuthel, Mara Flannery, Nina Siman, Keith S Goldfeld, Corita R Grudzen, and EMPallA Investigators.
• Department of Medicine (P.C.B.), University of Florida Health, Gainesville, Florida, USA.
• J Pain Symptom Manage. 2024 Dec 1; 68 (6): 583593583-593.

ContextOutpatient Palliative Care (OPC) benefits persons living with serious illness, yet barriers exist in utilization.ObjectivesTo identify factors associated with OPC clinic utilization.MethodsEmergency Medicine Palliative Care Access is a multicenter, randomized control trial comparing two models of palliative care for patients recruited from the Emergency Department (ED): nurse-led telephonic case management and OPC (one visit a month for six months). Patients were aged 50+ with advanced cancer or end-stage organ failure and recruited from 19 EDs. Using a mixed effects hurdle model, we analyzed patient, provider, clinic and healthcare system factors associated with OPC utilization.ResultsAmong the 603 patients randomized to OPC, about half (53.6%) of patients attended at least one clinic visit. Those with less than high school education were less likely to attend an initial visit than those with a college degree or higher (aOR 0.44; CI 0.23, 0.85), as were patients who required considerable assistance (aOR 0.45; CI 0.25, 0.82) or had congestive heart failure only (aOR 0.46; CI 0.26, 0.81). Those with higher symptom burden had a higher attendance at the initial visit (aOR 1.05; CI 1.00, 1.10). Reduced follow up visit rates were demonstrated for those of older age (aRR 0.90; CI 0.82, 0.98), female sex (aRR 0.84; CI 0.71, 0.99), and those that were never married (aRR 0.62; CI 0.52, 0.87).ConclusionEfforts to improve OPC utilization should focus on those with lower education, more functional limitations, older age, female sex, and those with less social support. Trial Registration ClinicalTrials.gov Identifier: NCT03325985.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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