What proportion of patients at the end of life contact out-of-hours primary care? A data linkage study in Oxfordshire

Brettell, Rachel; Fisher, Rebecca; Hunt, H. Allan; Garland, Sophie; Lasserson, Daniel; Hayward, Gail

doi:10.1136/bmjopen-2017-020244

Cited by 19 publications

(35 citation statements)

References 6 publications

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“…These clinical codes were validated by two members of the direct care team based on previous coding validity studies [16]. The positive predictive value (PPV) of the clinical code for medical diagnosis or conclusion was 92.6% [8]. In order to facilitate analysis these codes translated into International Classification of Primary Care (ICPC) codes by two clinically qualified authors (GH, RB) (supplementary Table 1).…”

Section: Methodsmentioning

confidence: 99%

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Paediatric contacts with the UK out-of-hours primary care service and contact outcomes: a regional service evaluation

Edwards¹,

Brettell²,

Bird

et al. 2020

BMC Fam Pract

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Background: Demand on hospital emergency departments for paediatric problems is increasing. However, the volume and nature of paediatric health demands placed on other parts of the urgent care system have not been explored. This understanding is an important first step in developing and improving out-of-hospital care. We aimed to describe the volume, nature, and outcomes of paediatric contacts with out-of-hours general practice (OOH GP). We performed a retrospective service evaluation using data from 12 months of paediatric patient contacts with the Oxfordshire OOH GP service. Methods: A database of contacts with the Oxfordshire OOH GP service was created for a 12 month period from December 2014 to November 2015. Descriptive statistics were calculated using SPSS Version 25. Results: 27,455 contacts were made by 18,987 individuals during a 12 month period. The majority of these were for children aged under 5. Over 70% of contacts were at the weekend. The peak contact period was between 18:30 and 21:30. Over 40% of contacts resulted in advice only (no onward referral, requirement for GP follow up, or prescription). 19.7% of contacts resulted in an antibiotic prescription, most commonly those linked with ear, chest, and throat infections. Discussion: Paediatric contacts with the Oxfordshire OOH GP service were predominantly in younger age groups and in the evening, with 19.7% resulting in an antibiotic prescription. Almost half of the contacts had no follow up or prescription, suggesting non-prescribing health care professionals could be involved in providing care in OOH GP. Further research should consider how children and their parents can be best supported to optimise OOH consulting.

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Section: Methodsmentioning

confidence: 99%

“…In the UK, the provision of primary care services outside core contracted hours is an integral NHS service [7] , [8]. In 2013-2014, 5.8 million cases were handled by OOH GP in England resulting in 3.3 million face-to-face consultations, including 800,000 home visits [9].…”

Section: Introductionmentioning

confidence: 99%

Paediatric contacts with the UK out-of-hours primary care service and contact outcomes: a regional service evaluation

Edwards¹,

Brettell²,

Bird

et al. 2020

BMC Fam Pract

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“…Patients who had contact with the OOH service in the 30 days prior to death were categorised into those who had been documented as palliative by the service and those who had not. We defined palliative patients as those who had been assigned a clinical code specific to palliative care, been referred to a hospice or been prescribed an appropriate subcutaneous medication by the OOH service, as described fully elsewhere (3). Demographical details were compared for patients rather than contacts, so that each patient was only considered once in the analysis.…”

Section: Methodsmentioning

confidence: 99%

“…Primary care plays a significant role at the end of life, with most patients spending the majority of their last year of life in the community and preferring to die at home (1,2). Out-of-hours (OOH) GP services are involved in end of life care for approximately 30% of patients (3). Provision of palliative care outside of working hours is a research priority, however, the role of OOH services prescribing palliative medications remains poorly understood (4,5).…”

Section: Aimmentioning

confidence: 99%

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Out-of-hours primary care end of life prescribing: a data linkage study

Brettell

Fisher

Hunt

et al. 2019

BMJ Support Palliat Care

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ObjectivesOut-of-hours (OOH) primary care services are contacted in the last 4 weeks of life by nearly 30% of all patients who die, but OOH palliative prescribing remains poorly understood. Our understanding of prescribing demand has previously been limited by difficulties identifying palliative patients seen OOH. This study examines the volume and type of prescriptions issued by OOH services at the end of life.MethodsA retrospective cohort study was performed by linking a database of Oxfordshire OOH service contacts over a year with national mortality data, identifying patients who died within 30 days of OOH contact. Demographic, service and prescribing data were analysed.ResultsA prescription is issued at 14.2% of contacts in the 30 days prior to death, compared with 29.9% of other contacts. The most common prescriptions were antibiotics (22.2%) and strong opioids (19%). 41.8% of prescriptions are for subcutaneously administered medication. Patients who were prescribed a syringe driver medication made twice as many OOH contacts in the 30 days prior to death compared with those who were not.ConclusionAbsolute and relative prescribing rates are low in the 30 days prior to death. Further research is required to understand what occurs at these non-prescribing end of life contacts to inform how OOH provision can best meet the needs of dying patients. Overall, relatively few patients are prescribed strong opioids or syringe drivers. When a syringe driver medication is prescribed this may help identify patients likely to be in need of further support from the service.

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A rapid systematic review of the effectiveness of out-of-hours palliative care telephone advice lines for people living at home and their carers

Johansson,

Chambers,

Curtis

et al. 2023

Preprint

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Background: People with palliative and end-of-life care needs in the community and their carers often rely on out-of-hours services to remain at home. Policymakers internationally have recommended implementation of telephone advice lines to ensure 24-hour access to support. However, little is known about their effectiveness. Aim: To review the evidence for the clinical and cost effectiveness of out-of-hours- telephone advice lines for adults with palliative care needs living at home and their carers, and report service characteristics associated with effectiveness. Design: Rapid systematic review, with narrative synthesis (PROSPERO ID: CRD42023400370). Data sources: Three databases (Medline, EMBASE, CINAHL) were searched in February 2023 for studies reporting on telephone advice lines with at least partial out-of-hours availability. Study quality was assessed using the Mixed Methods Appraisal Tool. Results: Twenty-one studies, published 2000-2022, were included. Most studies were observational; none were experimental. Three were comparative, and seven lacked explicit research questions or methods. Results were largely descriptive, focusing on service development and use, and process measures. Patient and carer outcomes were primarily reported qualitatively. Only two studies investigated possible system outcomes, by examining care-seeking behaviour after using telephone advice lines. Conclusion: Existing evidence for the effectiveness of telephone advice lines is limited. The lack of experimental studies evaluating individual or system-level outcomes prevents assessment of the effectiveness/cost-effectiveness of service models. There is a clear need for more rigorous evaluations using consistent reporting, and inclusion of patient and carer perspectives during both development and implementation. Recommendations for future evaluations are provided.

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What proportion of patients at the end of life contact out-of-hours primary care? A data linkage study in Oxfordshire

Cited by 19 publications

References 6 publications

Paediatric contacts with the UK out-of-hours primary care service and contact outcomes: a regional service evaluation

Paediatric contacts with the UK out-of-hours primary care service and contact outcomes: a regional service evaluation

Out-of-hours primary care end of life prescribing: a data linkage study

A rapid systematic review of the effectiveness of out-of-hours palliative care telephone advice lines for people living at home and their carers

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