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Using electronic primary care record searching to help identify people with palliative and anticipatory care needs for 24/7 care
  1. Bruce Mason1,
  2. Kirsty Boyd1,
  3. John Steyn2,
  4. Marilyn Kendall1 and
  5. Scott A Murray1
  1. 1Centre for Population Health Sciences, University of Edinburgh, Medical School, Teviot Place, Edinburgh, UK
  2. 2NHS Lothian, Edinburgh, Midlothian, UK

Abstract

Introduction Effective care planning and coordination is strongly associated with fewer hospital admissions in and out-of-hours.1,2 Many people who die are not being identified consistently for such pro-active care.3,4 Clinical indicators type tools (SPICT™ and GSF-PIG) help professionals identify people but more systematic screening is needed.5

Aim To develop an electronic tool using GP surgery software to output a list of patients who might benefit from anticipatory palliative care.

Methods Our prototype search was installed in GP software. It permitted “combination searches” generating a detailed set of outputs. The search was run 35 times in 10 practices over 9 months with iterated refinements to remove over-generation. The researcher attended 31 team meetings and conducted qualitative observations. The palliative care lead in each practice was interviewed.

Results Over 2,500 patients were identified. After refinement, the search reliably identified around 0.7% patients per practice. Practice teams used the list to prompt patient/carer reviews and often started or updated a Key Information Summary: the Scottish electronic, anticipatory care planning record. Running the searches in practices enabled participating teams to integrate them into their normal working routines.

Conclusions This ‘proof of concept’ study shows that systematic electronic searches of GP practice lists complements case-based identification by helping primary care teams identify more patients and carers who stand to benefit from a palliative care needs assessment, anticipatory care planning and having current information accessible out-of-hours. It informs future development of electronic primary and secondary care records across the UK.

References

  1. Mason BL, et al. Coordination of care for people at risk of dying in the next 12 months: a multi-site prospective study and consensus seeking exercise. NIHR Service Delivery and Organisation programme: London; 2013

  2. Addington-Hall J, et al. Variations in out of hours end of life care provision across primary care organisations in England and Scotland. Final Report, in NIHR Service and Delivery Organisation Programme, Southampton, UK; 2013

  3. Scottish Government, The primary medical services directed enhanced services (Scotland) 2012 palliative care H.a.S.C.I. Directorate, Editor. NHS Scotland: Edinburgh; 2012

  4. Murtagh FE, Bausewein C, Verne J, et al. How many people need palliative care? A study developing and comparing methods for population-based estimates. Palliat Med 2014;28(1):49–58

  5. Mason BL, Boyd K, Murray SA, et al. Developing a computerised search to help UK General Practices identify more patients for palliative care planning: a feasibility study. BMC Fam Pract 2015;16(1):99

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