Background As a result of service development through COVID-19, a community based Speciality Doctor was recruited to write ACPs for patients with progressive advanced neurological conditions through domiciliary visits. This study seeks to understand how their ACP may benefit patients and their primary health care providers (PHCP).

Methods

1. Retrospective cohort study, examining electronic hospital records 3 months pre-ACP/3 months post-ACP of 36 patients

2. Online survey of patient’s named PHCP

Results 36 patients were reviewed, diagnoses included advanced Parkinson’s disease/Parkinson’s plus, secondary multiple sclerosis, NF1 and superficial siderosis. 2 of these patients were known to hospice services before ACP commencement.

5 patients died since their ACP was made, all in their preferred place of care (home), with anticipatory medications, and without hospital or hospice input at end of life. Comparing 3 months pre to 3 months post ACP, ED attendances reduced from 35 to 9, and acute hospital inpatient stays reduced from 16 to 5 (136 to 21 bed days). 9 of 26 PHCPs surveyed replied. 89% (8) knew about the ACP but none had used it so far to make a clinical decision. 89% (8) felt confident of what an ACP is (8+/10 self scoring) with 33% (3) very confident to complete/review themselves. All responders felt happy for an ACP to be completed on behalf of them, concluding that it should be done by the ‘most appropriate’ ‘experienced clinician’ who ‘knows the patient best’.

Conclusions This study demonstrates the benefit from ACP in terms of achieving PPOC and avoiding hospital admissions. For these 36 patients, there were potentially 11 acute hospital admissions avoided, with a reduction in 115 bed days.

Data will be extended by a further 3 months by the time of the PCC. Future work gauging patient’s and carer’s opinion of ACP is planned.