Does Primary Care Model Effect Healthcare at the End of Life? A Population-Based Retrospective Cohort Study

Background: Increasing involvement of palliative care generalists may improve access to palliative care. It is unknown, however, if their involvement with and without palliative care specialists are associated with different outcomes. Aim: To describe physician-based models of palliative care and their association with healthcare utilization outcomes including: emergency department visits, acute hospitalizations and intensive care unit (ICU) admissions in last 30 days of life; and, place of death. Design: Population-based retrospective cohort study using linked health administrative data. We used descriptive statistics to compare outcomes across three models (generalist-only palliative care; consultation palliative care, comprising of both generalist and specialist care; and specialist-only palliative care) and conducted a logistic regression for community death. Setting/participants: All adults aged 18–105 who died in Ontario, Canada between April 1, 2012 and March 31, 2017. Results: Of the 231,047 decedents who received palliative services, 40.3% received generalist, 32.3% consultation and 27.4% specialist palliative care. Across models, we noted minimal to modest variation for decedents with at least one emergency department visit (50%–59%), acute hospitalization (64%–69%) or ICU admission (7%–17%), as well as community death (36%–40%). In our adjusted analysis, receipt of a physician home visit was a stronger predictor for increased likelihood of community death (odds ratio 9.6, 95% confidence interval 9.4–9.8) than palliative care model (generalist vs consultation palliative care 2.0, 1.9–2.0). Conclusion: The generalist palliative care model achieved similar healthcare utilization outcomes as consultation and specialist models. Including a physician home visit component in each model may promote community death.

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Primary Care Continuity and Wait Times to Receiving Breast Cancer Chemotherapy: A Population-Based Retrospective Cohort Study Using CanIMPACT Data

Current Oncology ◽

10.3390/curroncol28060405 ◽

2021 ◽

Vol 28 (6) ◽

pp. 4786-4804

Author(s):

Rachel Lin Walsh ◽

Aisha Lofters ◽

Rahim Moineddin ◽

Monika Krzyzanowska ◽

Eva Grunfeld

Keyword(s):

Breast Cancer ◽

Primary Care ◽

Cohort Study ◽

Cancer Patients ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Population Based ◽

Wait Times ◽

Breast Cancer Patients ◽

Breast Cancer Chemotherapy

(1) Background: Wait times to chemotherapy are associated with morbidity and mortality in breast cancer patients; however, it is unclear how primary care physician (PCP) continuity impacts these wait times, or whether this association is different in immigrants, who experience cancer care inequities. We assessed the association between PCP continuity and the contact-to-chemotherapy interval (wait time from when a patient first presents to healthcare to the first day of receiving breast cancer chemotherapy), with a specific look at the immigrant population. (2) Methods: Population-based, retrospective cohort study of women who were diagnosed with stage I–III breast cancer in Ontario who received surgery and adjuvant chemotherapy. We used quantile regression at the median and 90th percentile to quantify the effect of PCP continuity on the contact-to-chemotherapy interval, performing a separate analysis on the immigrant population. (3) Results: Among 12,781 breast cancer patients, including 1706 immigrants, the median contact-to-chemotherapy interval (126 days) was 3.21 days shorter (95% confidence interval (CI) 0.47–5.96) in symptom-detected patients with low PCP continuity, 10.68 days shorter (95% CI 5.36–16.00) in symptom-detected patients with no baseline PCP visits and 17.43 days longer (95% CI 0.90–34.76) in screen-detected immigrants with low PCP continuity compared to the same groups with high PCP continuity. (4) Conclusions: Higher PCP continuity was not associated with a change in the contact-to-chemotherapy interval for most of our study population, but was associated with a marginally longer interval in our symptom-detected population and a shorter contact-to-chemotherapy interval in screen-detected immigrants. This highlights the importance of PCP continuity among immigrants with positive screening results. Additionally, having no PCP visits at baseline was associated with a shorter contact-to-chemotherapy interval in symptom-detected patients.

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Exogenous sex steroid hormones and asthma in females: protocol for a population-based retrospective cohort study using a UK primary care database

BMJ Open ◽

10.1136/bmjopen-2017-020075 ◽

2018 ◽

Vol 8 (6) ◽

pp. e020075 ◽

Cited By ~ 5

Author(s):

Bright I Nwaru ◽

Colin R Simpson ◽

Ireneous N Soyiri ◽

Rebecca Pillinger ◽

Francis Appiagyei ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Steroid Hormones ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Population Based ◽

Sex Steroid Hormones ◽

Sex Steroid ◽

Primary Care Database ◽

Care Database

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Timing of GP end-of-life recognition in people aged ≥75 years: retrospective cohort study using data from primary healthcare records in England

British Journal of General Practice ◽

10.3399/bjgp20x713417 ◽

2020 ◽

Vol 70 (701) ◽

pp. e874-e879

Author(s):

Daniel Stow ◽

Fiona E Matthews ◽

Barbara Hanratty

Keyword(s):

Primary Care ◽

Palliative Care ◽

Cohort Study ◽

End Of Life ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Place Of Death ◽

Residential Home ◽

Primary Care Record ◽

Using Data

BackgroundHigh-quality, personalised palliative care should be available to all, but timely recognition of end of life may be a barrier to end-of-life care for older people.AimTo investigate the timing of end-of-life recognition, palliative registration, and the recording of end-of-life preferences in primary care for people aged ≥75 years.Design and settingRetrospective cohort study using national primary care record data, covering 34% of GP practices in England.MethodResearchOne data from electronic healthcare records (EHRs) of people aged ≥75 years who died in England between 1 January 2015 and 1 January 2016 were examined. Clinical codes relating to end-of-life recognition, palliative registration, and end-of-life preferences were extracted, and the number of months that elapsed between the code being entered and death taking place were calculated. The timing for each outcome and proportion of relevant EHRs were reported.ResultsDeath was recorded for a total of 13 149 people in ResearchOne data during the 1-year study window. Of those, 6303 (47.9%) records contained codes suggesting end of life had been recognised at a point in time prior to the month of death. Recognition occurred ≥12 months before death in 2248 (17.1%) records. In total, 1659 (12.6%) people were on the palliative care register and 457 (3.5%) were on the register for ≥12 months before death; 2987 (22.7%) records had a code for the patient’s preferred place of care, and 1713 (13.0%) had a code for the preferred place of death. Where preferences for place of death were recorded, a care, nursing, or residential home (n = 813, 47.5%) and the individual’s home (n = 752, 43.9%) were the most common.ConclusionEnd-of-life recognition in primary care appears to occur near to death and for only a minority of people aged ≥75 years. The findings suggest that older people’s deaths may not be anticipated by health professionals, compromising equitable access to palliative care.

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