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Palliative Care Does not Mean Stopping PAH Medication; A Case Study in Optimal Care Coordination

Catherina Madani

Sandra Lombardi


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Conference: 2014 International PHA Conference and Scientific Sessions

Release Date: 06.21.2014

Presentation Type: Abstracts

File Download: 2014 Conference Abstract - Catherina Madani

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Background: People with PAH have encountered difficulty obtaining reimbursement for certain PAH medication when seeking home care support through hospice or palliative care services. This has lead to patients experiencing unneccesarily long hospitals stays and fragmented suboptimal care. John is a 45-year old man who was diagnosed with PAH WHO Group 1 over two years ago. His comorbiditites include, HIV, depression, neuropathic leg pain, chronic venous insufficiency and lymphedma with leg ulcerations. He in functional class 111B, and receives a continuous infusion of Dopamine and epoprostenol. Over the last year, he has had multiple at home and refusal by long-term acre facilities to accept him due to the epoprostenol infusion. His unsteady gait has made him mostly wheelchair bound and his elderly parents whom he lives with, were unable to assist him when he previously feel at home. The extensive leg ulcerations have complicated his recovery and care management.

Methods: Jon was enrolled in an outpatient palliative care service a few days after being discharged from a 72-­‐day hospitalization. The Palliative Transitions Service (PTS) provides MD home visits every 30 days, weekly NP visits, LVN visits as needed, transportation to healthcare visits including his weekly wound care clinic and biweekly pulmonary clinic, as well as general care coordination. At one MD visit he reported leg pain when standing. PTS coordinated a mobile x-­‐ray in his home that ruled out a fracture and prevented an unnecessary trip to the ED. These services are fully covered by the patient’s MediCal. The patient and his mother manage the care, preparation and infusion of the epoprostenol, not the PTS. Overall PTS works as an olive branch of the hospital by working together to provide continuity of care in the home.

Results:The patient has not been readmitted since enrolling in palliative care over 3 months ago. His leg ulcers are being aggressively treated with an outpatient wound vac and are healing appropriately. At least one ED visit was averted and John has been consistently making all his medical appointments with ease since enrolling in PTS. Savings comes via cost avoidance of hospital stays estimated to be $3,000 to $4,000 a day. The patient reports, it's wonderful to be at home and receive all the care I need. I feel safe at home for the first time in a very long time. Conclusions:Palliative care’s focus is on improving quality of life for people living with chronic disease and assisting them to achieve care that is aligned with their goals. Patients with PAH can continue to receive aggressive care, including their PAH medications, while also receiving the supportive care they need to improve their quality of life and avoid unnecessary hospitalizations. Quality palliative care can benefit the patient foremost, but may also help to achieve the Institute of Healthcare Improvement’s (IHI) Triple Aim of: improving patients’ experiences of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of healthcare.

Type: Case Study