Identification of palliative care needs among people with dementia and its association with acute hospital care and community service use at the end-of-life: A retrospective cohort study using linked primary, community and secondary care data.
Dementia
end-of-life
family practice
hospitalisation
palliative care
primary health care
Journal
Palliative medicine
ISSN: 1477-030X
Titre abrégé: Palliat Med
Pays: England
ID NLM: 8704926
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
pubmed:
1
6
2021
medline:
15
1
2022
entrez:
31
5
2021
Statut:
ppublish
Résumé
Hospital admissions among people dying with dementia are common. It is not known whether identification of palliative care needs could help prevent unnecessary admissions. 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. 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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
OBJECTIVE
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
METHODS
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
METHODS
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
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
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.
Identifiants
pubmed: 34053356
doi: 10.1177/02692163211019897
pmc: PMC8532216
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1691-1700Subventions
Organisme : Medical Research Council
ID : MC_PC_19007
Pays : United Kingdom
Commentaires et corrections
Type : CommentIn
Références
Br J Gen Pract. 2012 May;62(598):e344-52
pubmed: 22546594
Br J Gen Pract. 2011 Jan;61(582):e12-21
pubmed: 21401985
J Gen Intern Med. 2008 Sep;23(9):1330-5
pubmed: 18506545
BMJ Open. 2017 Mar 9;7(3):e012546
pubmed: 28279992
Palliat Med. 2014 Jun;28(6):480-490
pubmed: 24534727
Fam Pract. 2013 Apr;30(2):172-8
pubmed: 23045354
Dementia (London). 2016 Sep;15(5):1234-45
pubmed: 25394556
Palliat Med. 2014 Feb;28(2):176-83
pubmed: 23779252
BMJ Support Palliat Care. 2020 Jun;10(2):145-156
pubmed: 30944119
BMC Fam Pract. 2015 Sep 22;16:126
pubmed: 26395257
J Am Geriatr Soc. 2016 Oct;64(10):1968-1974
pubmed: 27550751
Lancet Glob Health. 2019 Jul;7(7):e883-e892
pubmed: 31129125
Palliat Med. 2018 Mar;32(3):668-681
pubmed: 28922625
Fam Pract. 2006 Apr;23(2):253-63
pubmed: 16368704
Age Ageing. 2021 Feb 26;50(2):457-464
pubmed: 32946561
PLoS One. 2018 Jul 30;13(7):e0201051
pubmed: 30059515
Int J Palliat Nurs. 2016 Feb;22(2):76-81
pubmed: 26926347
Br J Gen Pract. 2011 Jun;61(587):e371-8
pubmed: 21801517
Int Psychogeriatr. 2015 Oct;27(10):1623-34
pubmed: 25573531
BMC Med. 2017 May 18;15(1):102
pubmed: 28514961
Palliat Med. 2012 Oct;26(7):879-86
pubmed: 21969310
N Engl J Med. 2011 Sep 29;365(13):1212-21
pubmed: 21991894
Dementia (London). 2016 Sep;15(5):1112-23
pubmed: 25305279
Age Ageing. 2019 Sep 1;48(5):672-679
pubmed: 31135024
Fam Pract. 2019 Oct 8;36(5):639-643
pubmed: 30649266
Aging Ment Health. 2014 May;18(4):400-10
pubmed: 24131061
Australas J Ageing. 2014 Mar;33(1):55-8
pubmed: 24520824
Cancer. 2018 Jul 15;124(14):3044-3051
pubmed: 29742292
BMC Geriatr. 2012 Sep 24;12:57
pubmed: 23006826
BMC Fam Pract. 2016 Nov 29;17(1):166
pubmed: 27894265
JAMA Intern Med. 2013 Sep 9;173(16):1534-40
pubmed: 23836056
Am J Epidemiol. 2004 Apr 1;159(7):702-6
pubmed: 15033648
PLoS One. 2019 Jun 21;14(6):e0218426
pubmed: 31226138
BMJ Open. 2015 Dec 16;5(12):e008650
pubmed: 26674496
BMC Med Inform Decis Mak. 2020 Apr 20;20(1):71
pubmed: 32312259
BMJ Qual Saf. 2013 Jan;22(1):53-64
pubmed: 22918988