Access to palliative care by persons with severe and persistent mental illnesses in Ontario

Abstract

Objectives: This study’s aims were to examine access to palliative care by persons with severe and persistent mental illnesses (SPMI), and determine the factors associated with access. Methods: This study employed a retrospective study design using health administrative data based on the interRAI home care assessment. The prevalence of access to palliative care (PC) among home care clients with and without SPMI was determined. Univariate and multivariate logistic regression models were fitted to assess the association between access to palliative care and the social-demographic and clinical factors that may influence access to palliative care. Results: Of the 616,296 home care clients, 155,642 (25.3%) had SPMI and 15,057 (2.5%) accessed PC. Of those who accessed PC, 23.5% (3,536) had SPMI. The association between SPMI and PC access was modified by sex (p-value=0.02) and age (p-value=0.04). Females less than 65 years who had SPMI had 15% lower odds (OR=0.85, CI=0.76, 0.95) of PC access compared to males who were more than 65 years and had no SPMI. Also, females aged 65-74 years with SPMI had 16% lower odds (OR=0.84, CI=0.76, 0.93) of PC access compared to males who were not aged 65-74 years and had no SPMI. Conclusion: Overall persons with SPMI had lower access to PC compared to those without SPMI, a disparity that demands pragmatic healthcare system policy changes to improve access.