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BEFORE THE TIPPING POINT: USING A COMPUTER RECORD SEARCH TO AID IDENTIFICATION OF PATIENTS WITH PALLIATIVE CARE NEEDS IN PRIMARY CARE
  1. Bruce Mason1,
  2. Kirsty Boyd1,
  3. Christine Campbell1,
  4. John Steyn2,
  5. Marilyn Kendall1,
  6. Peter Murchie3 and
  7. Scott Murray1
  1. 1 University of Edinburgh, Edinburgh, UK
  2. 2 NHS Lothian
  3. 3 University of Aberdeen

    Abstract

    Background Primary care is involved in the delivery of end-of-life care for approximately 600,000 people per year in the UK. Many patients who might benefit from proactive interventions at this time are not receiving them because they are not being identified as having “palliative” needs. The use of information technology currently in place in general practices provides opportunities to enhance identification of patients with such needs.

    Aims To develop and test a primary care electronic record search to identify patients with palliative care needs who are not already on a palliative care register. To assess the feasibility of such a search and its acceptability to primary care professionals.

    Methods A computer record search was developed then tested in a sample of practices in two Scottish health boards. Quantitative and qualitative data was collected to test the appropriateness of the search results and professional attitudes towards the method.

    Results The search was run in 10 practices with a total patient population of 83,229 and 69 health professionals present. For each practice, the search generated matches equal to 0.75% to 1.6% of the practice patient population. 30–60% of the patients returned by each search were considered to be at risk of dying by at least one GP. GPs struggled to suggest what additional care they could offer and found the term “palliative care” unhelpful. Although GPs found the search to be a useful tool they expressed reluctance to increase the size of their palliative care register.

    Conclusions The search successfully made GPs aware of patients who have palliative care needs. However GP attitudes towards palliative care meant that they lacked appropriate actions to take. This computer search is potentially useful but only if it can be paired with actions that can be taken without requiring use of the term “palliative care.”

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