Integration of Specialist Palliative Care into Tertiary Hospitals: A Multicenter Point Prevalence Survey from Thailand

Background: Accessibility and quality of hospital-based palliative care in Thailand have received scant attention. Objective: To determine the prevalence of inpatients who require in-hospital palliative care, to identify the proportion with access to specialist palliative care, and to define the factors associated with accessibility to specialist palliative care. Design: A cross-sectional analysis of a multicenter survey. Setting/Subjects: We surveyed all hospitalized patients from Thailand's four regions admitted to 14 tertiary care hospitals. Measurements: We used the Supportive and Palliative Care Indicators Tool to identify palliative care patients then reviewed their medical records. We categorized hospitalized palliative care patients into a palliative care consultation group and a nonconsultation group. The odds ratio (OR) between patient characteristics and patient groups was estimated using binary logistic regression. Results: One-fifth (18.7%) of hospitalized patients were palliative care patients, whereas only 17.3% received a specialist palliative care consult. Of these, one-third (28.4%) received advance care planning (ACP) documentation. One-quarter of patients in pain were not prescribed analgesics. The logistic regression analysis revealed that palliative care consultations were associated with patients >65 years (OR = 1.830, 95% confidence interval [CI]: 1.122-2.987), a cancer diagnosis (OR = 2.640, 95% CI: 1.478-4.718), strong opioids prescription (OR = 5.519, 95% CI: 3.217-9.469), and ACP documentation (OR = 50.149, 95% CI: 28.239-89.059). Conclusions: The prevalence of hospitalized palliative care patients in Thailand is comparable with that in developed countries; however, accessibility remains a significant gap, as specialist palliative care is associated with the quality of palliative care service.