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Out-of-hours primary care end of life prescribing: a data linkage study
  1. Rachel Brettell1,
  2. Rebecca Fisher1,2,
  3. Helen Hunt3,
  4. Sophie Garland3,
  5. Daniel Lasserson4 and
  6. Gail Hayward1
  1. 1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  2. 2Quality Team, The Health Foundation, London, UK
  3. 3Oxford Healthcare Improvement, Oxford Health NHS Foundation Trust, Oxford, UK
  4. 4Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Rachel Brettell, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UK; rachel.brettell{at}gmail.com

Abstract

Objectives Out-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.

Methods A 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.

Results A 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.

Conclusion Absolute 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.

  • drug administration
  • home care
  • service evaluation
  • end of life care
  • supportive care
  • terminal care
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Footnotes

  • Contributors GH and DL conceived the study. RF developed the protocol, gained study permissions and developed the databases. RB and GH analysed the data. HH and SG validated the dataset. RB and GH drafted the manuscript and all authors contributed to interpretation of results and critical revision of the manuscript.

  • Funding This work was supported by the Oxfordshire Health Services Research Committee (grant number 1176). GH holds an NIHR-funded Academic Clinical Lectureship, RF and RB were supported by NIHR Academic Clinical fellowships.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study had Research Ethics approval from South Central - Berkshire Research Ethics Committee (REC number 15/SC/0754).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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