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See also AIHW glossary
A general practitioner is a medical practitioner who provides primary comprehensive and continuing care to patients and their families within the community.
When the IRSD is used in this report, people living in the 20% of areas with the greatest overall level of disadvantage are described as living in the 'lowest socioeconomic areas'. The 20% of people at the other end of the scale -those living in areas with the least overall level of disadvantage -are described as living in the 'highest socioeconomic areas'.
It is important to note that the IRSD reflects the overall or average socioeconomic position of the population of an area; it does not show how individuals living in the same area might differ from each other in their socioeconomic position. See Classifications for further information.
Outcome measure 1: Time from date ready for care to episode start'Time from date ready for care to episode start' relates to the responsiveness of palliative care services to patient needs. This measure is the time (in days) between the date the patient is ready for care and the date of the episode start and is measured for all episodes of care and across all settings of care.This measure replaced 'Time from referral to first contact for the episode'. However, following feedback and consultation with PCOC participants, this measure was superseded in July 2013.Outcome measure 2: Time in unstable phaseThis outcome measure relates to the number of patients in the 'unstable phase' and the number of days they remain in an unstable phase during their episode of care. The unstable phase, by nature of its definition, alerts clinical staff to the need for urgent or emergency intervention. This phase shows the effectiveness of the intervention(s) implemented for a specific new problem or the worsening of an existing problem. Those patients assessed to be in the unstable phase should have their problem(s) managed and under control within this period of time, regardless of the setting of care.This measure was originally associated with three benchmarks. However, following consultation at the 2012 PCOC benchmarking workshops, these were replaced with one consolidated benchmark.Outcome measure 3: Change in painPain management is acknowledged as a 'core business' of palliative care services; hence, measuring patient distress from pain is considered an important outcome for palliative care services. Two of the five assessment tools used in PCOC are used to measure pain: the Symptom Assessment Scale (SAS) (a patient-rated tool) and the Palliative Care Problem Severity Score (PCPSS) (a clinician-rated tool).Palliative care patients are assessed at two levels of outcomes for pain. These are:
Ideally, those patients with absent/mild pain at the beginning of the phase should be maintained with absent/mild pain at the end of the phase. Similarly, patients in moderate/severe pain at the start of a phase should be able to achieve mild/absent pain at the end of the phase.Any change in pain is measured by the difference in pain score from the beginning of a phase to the end of a phase and is calculated using both PCPSS (severity of) and SAS (distress from) pain measures.
A Palliative care-related encounter is an encounter which includes GP recorded terms relevant to one or more of the four ICPC-2 PLUS palliative care-related terms in one or more of the following three BEACH survey data elements:
The four ICPC-2 PLUS palliative care terms are:
A28011 Palliative care
A46020 Palliative care consultation
A67015 Referral; hospice
Unless otherwise defined, palliative care-related prescriptions are defined in this section as medications listed in the Pharmaceutical Benefits for Palliative Care Schedule. The information on prescription medicines in this section has been sourced from the PBS/RPBS and refers to medications prescribed by clinicians and subsequently dispensed in community pharmacies (or, for Section 100 drugs, by hospital pharmacies). Consequently, it is a count of medications dispensed rather than a count of prescriptions written by clinicians.
Phase level data items describe a palliative care patient's stage of illness, functional impairment and their levels of pain and symptom distress. Five assessment tools are used to describe the clinical condition of a patient, which, in turn, contribute to a patient's care plan. These assessment tools are phase of care, SAS, PCPSS, Australia-modified-Karnofsky Performance Status (AKPS), and Resource Utilisation Groups-Activities of Daily Living (RUG-ADL) which provide measures of quality and outcomes of care.
The PCOC analyses each service's data and compares these with the national average. The items at the phase level are used to quantify patient outcomes and are the focus of the PCOC benchmarks. The 4 palliative care phases are:
1. Stable phase
Stable Phase Start: Patient problems and symptoms are adequately controlled by an established plan of care; further interventions to maintain symptom control and quality of life have been planned and the family/carer(s) situation is relatively stable and no new issues are apparent.
Stable Phase End: The needs of the patient and or family/carer(s) increase, requiring changes to the existing plan of care.
2. Unstable phase
Unstable Phase Start: An urgent change in the plan of care or emergency treatment is required as the patient experiences a new problem that was not anticipated in the existing plan of care; and/or the patient experiences a rapid increase in the severity of a current problem; and/or the circumstances of the patient's family/carer(s) change suddenly, impacting on patient care.
Unstable Phase End: The new plan of care is in place; it has been reviewed and no further changes to the care plan are required. This does not necessarily mean that the symptom crisis has fully resolved but there is a clear diagnosis and plan of care (that is, the patient is stable or deteriorating) and/or death is likely within days (that is, the patient is now terminal).
3. Deteriorating phase
Deteriorating Phase Start: The care plan is addressing anticipated needs but requires periodic review because the patient's overall functional status is declining; the patient has a gradual worsening of existing problem and/or a new but anticipated problem; and/or the carer(s)/family undergo(es) gradually worsening distress that impacts on the patient's care.
Deteriorating Phase End: The patient condition plateaus (that is, the patient is now stable); or there is an urgent change in the care plan or emergency treatment; and/or the family/carer(s) have a sudden change in their situation that impacts on patient care, and urgent intervention is required (that is, the patient is now unstable); or death is likely within days (that is, the patient is now terminal).
4. Terminal phase
Terminal Phase Start: Death is likely within days.
Australian Bureau of Statistics (ABS) 2008: Index of Relative Socio-Economics Disadvantage (IRSD). Canberra. Viewed March 2015.
Australian and New Zealand Society of Palliative Medicine (ANZSPM) 2008. Defining the meaning of the terms consultant physician in palliative medicine and palliative medicine specialist. Canberra: ANZSPM. Viewed 21 April 2015.
Palliative care Australia
Department of Health—palliative care