We highlight the importance of informal communication in supporting patient care and the gaps in the system contributing to their necessity. Changes at the system level are needed to ensure we are not leaving important collaborative opportunities to chance alone.
Background Most patients nearing the end of life can benefit from a palliative approach in primary care. We currently do not know how to measure a palliative approach in family practice. The objective of this study was to describe the provision of a palliative approach and evaluate clinicians’ perceptions of the results. Methods We conducted a descriptive study of deceased patients in an interprofessional team family practice. We integrated conceptual models of a palliative approach to create a chart review tool to capture a palliative approach in the last year of life and assessed a global rating of whether a palliative approach was provided. Clinicians completed a questionnaire before learning the results and after, on perceptions of how often they believed a palliative approach was provided by the team. Results Among 79 patients (mean age at death 73 years, 54% female) cancer and cardiac diseases were the top conditions responsible for death. One-quarter of patients were assessed as having received a palliative approach. 53% of decedents had a documented discussion about goals of care, 41% had nurse involvement, and 15.2% had a discussion about caregiver well-being. These indicators had the greatest discrimination between a palliative approach or not. Agreement that elements of a palliative approach were provided decreased significantly on the clinician questionnaire from before to after viewing the results. Conclusions This study identified measurable indicators of a palliative approach in family practice, that can be used as the basis for quality improvement.
BackgroundThe greatest impact of the COVID-19 pandemic in Canada has been on long-term care facilities which have accounted for a large majority of the mortality seen in this country. We developed a clinical response team to perform mass as-sessment and provide support to long-term care facilities in Eastern Ontario with large outbreaks in the hope of reducing the impact of the outbreaks. MethodsThis is a retrospective cohort study of all residents of LTC facilities supported by our multidisciplinary clinical response team. We collected data about the timing of the outbreak and our deployment, as well as the total number of COVID-19 cases and deaths, and measured the correlation between the timing of our deployment and the observed mortality rate. ResultsOur clinical team was deployed to 14 long-term care facilities, representing 719 cases and 243 deaths (mean ± standard error of mortality 34% ± 4%). Our team was deployed a mean ± standard error of 16 ± 2 days after the declaration of an out-break. There was a significant correlation between an earlier deployment of our clinical team and a lower mortality rate for that outbreak (Pearson’s r = 0.70, p < .01). InterpretationThis retrospective, uncontrolled study of a non-standardized intervention has many potential limitations. However, the data suggest that timely deployment of our clinical response team may improve outcomes in the event of a large outbreak. This clinical team may be useful in future pandemics.
ObjectivesPrescribing of symptom management medications may reflect the quality of end-of-life care provided to nursing home residents who are nearing death. The objective of this study was to examine variations in the prescribing of end-of-life symptom management medications in nursing home residents in the last 14 days of life. ApproachThis was a retrospective cohort study of nursing home residents age 65+ who died in Ontario, Canada between January 2017 and February 2020. Through expert consultations, we compiled a list of medications used to manage common end-of-life symptoms. Using routinely collected health administrative data held at ICES, we linked resident data to prescription claims to identify whether residents were prescribed these medications in the last 14 days of life. We grouped nursing homes into quintiles according to the proportion of decedents in a home who received ≥1 prescription and examined variations in resident and facility characteristics across quintiles. ResultsThere were 55,029 deaths across 626 nursing homes. Overall, 64.8% of residents received at least one end-of-life symptom management medication. The proportion of dying residents who received ≥1 end-of-life medication ranged from 37.6% in quintile 1, 59.8% in quintile 2, 69.1% in quintile 3, 74.8% in quintile 4, and 82.9% in quintile 5. Opioids were the most commonly prescribed medications, with an average of 62.2% of residents receiving a prescription (35.9% to 81.2% across the quintiles). Nursing home residents that resided in homes in the lowest prescribing quintile were older and more likely to be Allophones (first language not English or French). Low prescribing homes were also larger, with a higher number of beds, and were more likely to be in rural areas. ConclusionThe observed variations in the prescribing of medications to manage end-of-life symptoms in nursing home residents raises concerns that some residents may have received inadequate end-of-life symptom management. Prescription data may provide an opportunity to rapidly evaluate the quality of end-of-life care in nursing homes at a population level.
ObjectivesOur preliminary work revealed significant variations in the prescribing of end-of-life symptom management medications in nursing homes prior to the onset of the COVID-19 pandemic. In this study, we sought to explore whether the prescribing of end-of-life medications in nursing homes changed with the onset of the pandemic. ApproachThis was a retrospective cohort study of nursing home residents age 65+ who died in Ontario, Canada, divided into two time periods based on death date: pre-COVID-19 (January 1st, 2017 – March 17th, 2020) and during COVID-19 (March 18th, 2020 – March 31st, 2021). Using routinely collected health administrative data and our evidence-based end-of-life medications list, we linked resident data to prescription claims to identify whether residents were prescribed these medications in the last 14 days of life. We grouped homes into quintiles according to the proportion of decedents who received ≥1 prescription and examined changes in prescribing before and during COVID-19. ResultsNursing homes in the lowest prescribing quintile prescribed, on average, 11.5% fewer end-of-life symptom management medications during COVID-19 compared to pre-pandemic. Conversely, homes in the highest quintile prescribed an average of 13.7% more medications during COVID-19. Nursing homes in the lowest quintile had more COVID-19-positive residents (33% of residents) compared to homes in the highest quintile (9% of residents). Additionally, nursing homes in the lowest prescribing quintile spent more time with active COVID-19 outbreaks compared to homes in the highest quintile (mean 72.7 days versus 24.1 days, respectively, standardized difference 0.819). ConclusionThe COVID-19 pandemic has disproportionately impacted nursing homes across Canada. Our findings suggest that nursing homes with low rates of prescribing of end-of-life medications prior to the pandemic had even lower prescribing rates during the pandemic. These homes were also harder hit by COVID-19 infections and outbreaks.
Background: Most patients nearing the end of life can benefit from a palliative approach in primary care. We currently do not know how to measure a palliative approach in family practice. The objective of this study was to describe the provision of a palliative approach and evaluate their clinicians’ perceptions of the results.Methods: We conducted a descriptive study of deceased patients in an interprofessional team family practice. We integrated conceptual models of a palliative approach to create a chart review tool to capture a palliative approach in the last year of life and assessed a global rating of whether a palliative approach was provided. Clinicians completed a questionnaire before learning the results and after, on perceptions of how often they believed a palliative approach was provided by the team.Results: Among 79 patients (mean age at death 73 years, 54% female) cancer and cardiac diseases were the top conditions responsible for death. One-quarter of patients were assessed as having received a palliative approach. 53% of decedents had a documented discussion about goals of care, 41% had nurse involvement, and 15.2% had a discussion about caregiver well-being. These indicators had the greatest discrimination between a palliative approach or not. Agreement that elements of a palliative approach were provided decreased significantly on the clinician questionnaire from before to after viewing the results. Conclusions: This study identified measurable indicators of a palliative approach in family practice, that can be used as the basis for quality improvement.
Background: Most patients nearing the end of life can benefit from a palliative approach in primary care. We currently do not know how to measure a palliative approach in family practice. The objective of this study was to describe the provision of a palliative approach and evaluate their clinicians’ perceptions of the results.Methods: We conducted a descriptive study of deceased patients in an interprofessional team family practice. We integrated conceptual models of a palliative approach to create a chart review tool to capture a palliative approach in the last year of life and assessed a global rating of whether a palliative approach was provided. Clinicians completed a questionnaire before learning the results and after, on perceptions of how often they believed a palliative approach was provided by the team.Results: Among 79 patients (mean age at death 73 years, 54% female) cancer and cardiac diseases were the top conditions responsible for death. One-quarter of patients were assessed as having received a palliative approach. 53% of decedents had a documented discussion about goals of care, 41% had nurse involvement, and 15.2% had a discussion about caregiver well-being. These indicators had the greatest discrimination between a palliative approach or not. Agreement that elements of a palliative approach were provided decreased significantly on the clinician questionnaire from before to after viewing the results. Conclusions: This study identified measurable indicators of a palliative approach in family practice, that can be used as the basis for quality improvement.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.