UNDERSTANDING THE BARRIERS TO IDENTIFYING CARERS OF PEOPLE WITH SUPPORTIVE AND PALLIATIVE CARE NEEDS IN PRIMARY CARE

Background: Hospital admissions among people dying with dementia are common. It is not known whether identification of palliative care needs could help prevent unnecessary admissions. Aim: To examine the proportion of people with dementia identified as having palliative care needs in their last year of life, and the association between identification of needs and primary, community and hospital services in the last 90 days. Design: Retrospective cohort study using Discover, an administrative and clinical dataset from 365 primary care practices in London with deterministic individual-level data linkage to community and hospital records. Setting/participants: People diagnosed with dementia and registered with a general practitioner in North West London (UK) who died between 2016 and 2019. The primary outcome was multiple non-elective hospital admissions in the last 90 days of life. Secondary outcomes included contacts with primary and community care providers. We examined the association between identification of palliative care needs with outcomes. Results: Among 5804 decedents with dementia, 1953 (33.6%) were identified as having palliative care needs, including 1141 (19.7%) identified before the last 90 days of life. Identification of palliative care needs before the last 90 days was associated with a lower risk of multiple hospital admissions (Relative Risk 0.70, 95% CI 0.58–0.85) and more contacts with the primary care practice, community nurses and palliative care teams in the last 90 days. Conclusions: Further investigation of the mechanisms underlying the association between identification of palliative care needs and reduced hospital admissions could help reduce reliance on acute care for this population.

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Primary care service use by end-of-life cancer patients: a nationwide population-based cohort study in the United Kingdom

10.21203/rs.2.14885/v3 ◽

2020 ◽

Author(s):

Wei Gao ◽

Martin Gulliford ◽

Myfanwy Morgan ◽

Irene J Higginson

Keyword(s):

Primary Care ◽

Palliative Care ◽

Cohort Study ◽

End Of Life ◽

Cancer Patients ◽

Care Needs ◽

Explanatory Variables ◽

Care Services ◽

The United Kingdom ◽

Palliative Care Needs

Abstract Background End of life(EoL) care becomes more complex and increasingly takes place in the community, but there is little data on the use of general practice(GP) services to guide care improvement. This study aims to determine the trends and factors associated with GP consultation, prescribing and referral to other care services amongst cancer patients in the last year of life. Methods A retrospective cohort study of cancer patients who died in 2000-2014, based on routinely collected primary care data(the Clinical Practice Research DataLink, CPRD) covering a representative sample of the population in the United Kingdom. Outcome variables were number of GP consultations(primary), number of prescriptions and referral to other care services(yes vs no) in the last year of life. Explanatory variables included socio-demographics, clinical characteristics and the status of palliative care needs recognised or not. The association between outcome and explanatory variables were evaluated using multiple-adjusted risk ratio(aRR). Results Of 68,523 terminal cancer patients, 70% were aged 70+, 75% had comorbidities and 45.5% had palliative care needs recognised. In the last year of life, a typical cancer patient had 43 GP consultations(Standard deviation(SD): 31.7; total=3,031,734), 71.5 prescriptions(SD: 68.0; total=5,074,178), and 21(SD: 13.0) different drugs; 58.0% of patients had at least one referral covering all main clinical specialities. More comorbid conditions, prostate cancer and having palliative care needs recognised were associated with more primary care consultations, more prescriptions and a higher chance of referral(aRRs 1.07-2.03). Increasing age was related to fewer consultations(aRRs 0.77-0.96), less prescriptions(aRR 1.09-1.44), and a higher chance of referral(aRRs 1.08-1.16) but less likely to have palliative care needs recognised(aRRs 0.53-0.89). Conclusions GPs are very involved in end of life care of cancer patients, most of whom having complex care needs, i.e. older age, comorbidity and polypharmacy. This highlights the importance of enhancing primary palliative care skills among GPs and the imperative of greater integration of primary care with other healthcare professionals including oncologists, palliative care specialists, geriatricians and pharmacists. Research into the potential of deprescribing is warranted. Older patients have poorer access to both primary care and palliative care need to be addressed in future practices.

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What tools are available to identify patients with palliative care needs in primary care: a systematic literature review and survey of European practice

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2013-000527 ◽

2013 ◽

Vol 3 (4) ◽

pp. 444-451 ◽

Cited By ~ 67

Author(s):

Elke Arnoldina Theodora Maas ◽

Scott A Murray ◽

Yvonne Engels ◽

Christine Campbell

Keyword(s):

Primary Care ◽

Palliative Care ◽

Literature Review ◽

Systematic Literature Review ◽

Care Needs ◽

Palliative Care Needs

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Rural palliative care needs: a survey of primary care professionals in Powys, Wales

International Journal of Palliative Nursing ◽

10.12968/ijpn.2001.7.12.9286 ◽

2001 ◽

Vol 7 (12) ◽

pp. 610-615 ◽

Cited By ~ 13

Author(s):

Bill Noble ◽

Philippa Hughes ◽

Christine Ingleton ◽

David Clark

Keyword(s):

Primary Care ◽

Palliative Care ◽

Care Needs ◽

Palliative Care Needs ◽

Primary Care Professionals

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Identification of patients with potential palliative care needs: A systematic review of screening tools in primary care

Palliative Medicine ◽

10.1177/0269216320929552 ◽

2020 ◽

Vol 34 (8) ◽

pp. 989-1005 ◽

Cited By ~ 3

Author(s):

Yousuf ElMokhallalati ◽

Stephen H Bradley ◽

Emma Chapman ◽

Lucy Ziegler ◽

Fliss EM Murtagh ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Palliative Care ◽

Functional Decline ◽

Screening Tools ◽

Care Needs ◽

Early Access ◽

Wide Range ◽

Registration Number ◽

Palliative Care Needs

Background: Despite increasing evidence of the benefits of early access to palliative care, many patients do not receive palliative care in a timely manner. A systematic approach in primary care can facilitate earlier identification of patients with potential palliative care needs and prompt further assessment. Aim: To identify existing screening tools for identification of patients with advanced progressive diseases who are likely to have palliative care needs in primary healthcare and evaluate their accuracy. Design: Systematic review (PROSPERO registration number CRD42019111568). Data sources: Cochrane, MEDLINE, Embase and CINAHL were searched from inception to March 2019 Results: From 4,127 unique articles screened, 25 reported the use or development of 10 screening tools. Most tools use prediction of death and/or deterioration as a proxy for the identification of people with potential palliative care needs. The tools are based on a wide range of general and disease-specific indicators. The accuracy of five tools was assessed in eight studies; these tools differed significantly in their ability to identify patients with potential palliative care needs with sensitivity ranging from 3% to 94% and specificity ranging from 26% to 99%. Conclusion: The ability of current screening tools to identify patients with advanced progressive diseases who are likely to have palliative care needs in primary care is limited. Further research is needed to identify standardised screening processes that are based not only on predicting mortality and deterioration but also on anticipating the palliative care needs and predicting the rate and course of functional decline. This would prompt a comprehensive assessment to identify and meet their needs on time.

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