• 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, University of Florida Health, Gainesville, FL USA.
• J Pain Symptom Manage. 2024 Aug 21.

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 6 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 IdentifierNCT03325985.Copyright © 2024. Published by Elsevier Inc.

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