Reducing avoidable admissions in rural community palliative care: a pilot study of care coordination by General Practice registrars

Abstract Objective End-of-life and anticipatory medications (AMs) have been widely used in various health care settings for people approaching end-of-life. Lack of access to medications at times of need may result in unnecessary hospital admissions and increased patient and family distress in managing palliative care at home. The study aimed to map the use of end-of-life and AM in a cohort of palliative care patients through the use of the Population Level Analysis and Reporting Data Space and to discuss the results through stakeholder consultation of the relevant organizations. Methods A retrospective observational cohort study of 799 palliative care patients in 25 Australian general practice health records with a palliative care referral was undertaken over a period of 10 years. This was followed by stakeholders’ consultation with palliative care nurse practitioners and general practitioners who have palliative care patients. Results End-of-life and AM prescribing have been increasing over the recent years. Only a small percentage (13.5%) of palliative care patients received medications through general practice. Stakeholders’ consultation on AM prescribing showed that there is confusion about identifying patients needing medications for end-of-life and mixed knowledge about palliative care referral pathways. Significance of results Improved knowledge and information around referral pathways enabling access to palliative care services for general practice patients and their caregivers are needed. Similarly, the increased utility of screening tools to identify patients with palliative care needs may be useful for health care practitioners to ensure timely care is provided.

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Feasibility and Acceptability of Nurse-Led Primary Palliative Care for Older Adults with Chronic Conditions: A Pilot Study

Journal of Palliative Medicine ◽

10.1089/jpm.2017.0666 ◽

2018 ◽

Vol 21 (8) ◽

pp. 1114-1121 ◽

Cited By ~ 1

Author(s):

Shigeko (Seiko) Izumi ◽

Basilia Basin ◽

Margo Presley ◽

Jean McCalmont ◽

Jon P. Furuno ◽

...

Keyword(s):

Older Adults ◽

Palliative Care ◽

Pilot Study ◽

Chronic Conditions

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Migraine Headache in a Rural Community in Nigeria: Results of a Pilot Study

Neuroepidemiology ◽

10.1159/000110687 ◽

1982 ◽

Vol 1 (1) ◽

pp. 31-39 ◽

Cited By ~ 23

Author(s):

B.O. Osuntokun ◽

Bruce S. Schoenberg ◽

V. Nottidge ◽

A. Adeuja ◽

O. Kale ◽

...

Keyword(s):

Pilot Study ◽

Rural Community ◽

Migraine Headache

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Interdisciplinary Perinatal Palliative Care Coordination, Birth Planning, and Support of the Team

Perinatal Palliative Care ◽

10.1007/978-3-030-34751-2_15 ◽

2020 ◽

pp. 333-355

Author(s):

Emilie Lamberg Jones ◽

Steven R. Leuthner

Keyword(s):

Palliative Care ◽

Care Coordination ◽

Birth Planning ◽

Perinatal Palliative Care

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Attitudes to chlamydia screening in general practice among Australian university students: a pilot study

Sexual Health ◽

10.1071/sh07097 ◽

2008 ◽

Vol 5 (4) ◽

pp. 359 ◽

Cited By ~ 8

Author(s):

Bernadette Zakher ◽

Melissa Kang

Keyword(s):

At Risk ◽

General Practice ◽

Pilot Study ◽

Young People ◽

University Students ◽

Risk Group ◽

Chlamydia Infection ◽

Chlamydia Screening ◽

Sexually Active ◽

Sexually Transmissible Infections

Background: Chlamydia screening of sexually active young people in general practice is key to the Australian National Sexually Transmissible Infections Strategy 2005–2008. Overseas research indicates that young people have positive attitudes towards opportunistic screening by a general practitioner (GP). This pilot study aims to investigate the attitudes of Australian university students towards chlamydia screening in primary care. Methods: Students (16–25 years) attending a class in one of three faculties at the University of Sydney participated by completing a questionnaire, which collected information about demographics, sexual history, chlamydia knowledge, attitudes towards and preferences for chlamydia screening. Results: One hundred and eighty-five students (78% female) returned questionnaires (participation rate 92%). Arts students were younger, more likely to be sexually active and to report having little or no knowledge of chlamydia. Males in the study were less likely to have had sex as a group compared to the group of females in the sample. Science students were also less likely to have had sex compared to their counterparts in other faculties. Seventy-six percent of students were comfortable with opportunistic testing for chlamydia by their GP. Reasons for not being comfortable included ‘don’t think I’m at risk’ (65%) and ‘not comfortable discussing sexual matters with my GP’ (38%). Although comfortable with GP-based testing, the likelihood of being tested in the upcoming year for most students was low, as was personal concern about chlamydia infection. Conclusions: Findings suggest that the most at risk group for chlamydia infection is not well educated about their risk of infection. The limited numbers of tests among sexually active individuals in this sample indicate that health practitioners are not screening this high-risk group for chlamydia infection.

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Evaluation of the General Practice Pharmacist (GPP) intervention to optimise prescribing in Irish primary care: a non-randomised pilot study

BMJ Open ◽

10.1136/bmjopen-2019-035087 ◽

2020 ◽

Vol 10 (6) ◽

pp. e035087

Author(s):

Karen Cardwell ◽

Susan M Smith ◽

Barbara Clyne ◽

Laura McCullagh ◽

Emma Wallace ◽

...

Keyword(s):

Primary Care ◽

General Practice ◽

Pilot Study ◽

Medication Review ◽

Controlled Trial ◽

Cost Savings ◽

Practice Team ◽

Patient Reported ◽

General Practices ◽

Medication Changes

ObjectiveLimited evidence suggests integration of pharmacists into the general practice team could improve medicines management for patients, particularly those with multimorbidity and polypharmacy. This study aimed to develop and assess the feasibility of an intervention involving pharmacists, working within general practices, to optimise prescribing in Ireland.DesignNon-randomised pilot study.SettingPrimary care in Ireland.ParticipantsFour general practices, purposively sampled and recruited to reflect a range of practice sizes and demographic profiles.InterventionA pharmacist joined the practice team for 6 months (10 hours/week) and undertook medication reviews (face to face or chart based) for adult patients, provided prescribing advice, supported clinical audits and facilitated practice-based education.Outcome measuresAnonymised practice-level medication (eg, medication changes) and cost data were collected. Patient-reported outcome measure (PROM) data were collected on a subset of older adults (aged ≥65 years) with polypharmacy using patient questionnaires, before and 6 weeks after medication review by the pharmacist.ResultsAcross four practices, 786 patients were identified as having 1521 prescribing issues by the pharmacists. Issues relating to deprescribing medications were addressed most often by the prescriber (59.8%), compared with cost-related issues (5.8%). Medication changes made during the study equated to approximately €57 000 in cost savings assuming they persisted for 12 months. Ninety-six patients aged ≥65 years with polypharmacy were recruited from the four practices for PROM data collection and 64 (66.7%) were followed up. There were no changes in patients’ treatment burden or attitudes to deprescribing following medication review, and there were conflicting changes in patients’ self-reported quality of life.ConclusionsThis non-randomised pilot study demonstrated that an intervention involving pharmacists, working within general practices is feasible to implement and has potential to improve prescribing quality. This study provides rationale to conduct a randomised controlled trial to evaluate the clinical and cost-effectiveness of this intervention.

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