Patient and attendance level factors associated with cancer decedents being a frequent or very frequent unscheduled care attender
| Patient level analysis: (reference category = non-attenders (n=539 cancer decedents)) | |||||
| Patient level factors | Patients (n) (%) | Univariate: unadjusted OR (95% CI) | p value (adj) | Multivariate:adjusted OR | |
| Frequent attenders | Age | ||||
| (5–9 attendances per year) | <65 | 73 (18.0) | 0.61 (0.40 to 0.92) | 0.001 | 0.48 (0.31 to 0.74) |
| (n=406 cancer decedents) | 65–74 | 103 (25.4) | 0.61 (0.42 to 0.89) | 0.002 | 0.54 (0.36 to 0.80) |
| 75–84 | 133 (32.8) | 0.73 (0.51 to 1.06) | 0.05 | 0.68 (0.47 to 1.00) | |
| ≥85 (ref) | 97 (23.9) | 1 | . | 1 | |
| Cancer type | |||||
| Lung | 112 (27.6) | 0.76 (0.50 to 1.15) | 0.16 | 0.74 (0.48 to 1.13) | |
| Upper GI | 84 (20.7) | 0.64 (0.42 to 0.98) | 0.02 | 0.60 (0.38 to 0.93) | |
| Bowel | 58 (14.3) | 0.96 (0.59 to 1.56) | 0.55 | 0.86 (0.52 to 1.43) | |
| Breast; ovarian | 37 (9.1) | 0.64 (0.38 to 1.09) | 0.02 | 0.51 (0.29 to 0.90) | |
| Prostate | 19 (4.7) | 1.03 (0.50 to 2.12) | 0.74 | 0.88 (0.41 to 1.88) | |
| Haematological | 25 (6.2) | 0.37 (0.21 to 0.66) | 0.001 | 0.36 (0.20 to 0.64) | |
| Other (ref) | 71 (17.5) | 1 | . | 1 | |
| Rurality grouped | |||||
| Urban | 270 (67.8) | 0.76 (0.49 to 1.18) | 0.44 | 0.83 (0.52 to 1.33) | |
| Accessible | 79 (19.8) | 0.43 (0.26 to 0.70) | 0.001 | 0.43 (0.26 to 0.71) | |
| Remote (ref) | 49 (12.3) | 1 | . | 1 | |
| Deprivation | |||||
| SIMD5 1 | 78 (19.6) | 1.76 (1.12 to 2.77) | 0.04 | 1.64 (1.02 to 2.62) | |
| SIMD5 2 | 55 (13.8) | 1.51 (0.93 to 2.44) | 0.21 | 1.38 (0.84 to 2.27) | |
| SIMD5 3 | 79 (19.8) | 1.42 (0.92 to 2.21) | 0.06 | 1.53 (0.98 to 2.40) | |
| SIMD5 4 | 133 (33.4) | 1.61 (1.07 to 2.40) | 0.007 | 1.79 (1.18 to 2.72) | |
| SIMD5 5 (ref) | 53 (13.3) | 1 | . | 1 | |
| Time between diagnosis and death | |||||
| 0–12 weeks before death | 108 (26.6) | 0.60 (0.43 to 0.83) | 0.001 | 0.54 (0.38 to 0.77) | |
| 13–25 weeks before death | 63 (15.5) | 1.16 (0.77 to 1.75) | 0.74 | 1.08 (0.70 to 1.67) | |
| 26–38 weeks before death | 56 (13.8) | 1.64 (1.04 to 2.61) | 0.04 | 1.67 (1.03 to 2.70) | |
| 39–51 weeks before death | 46 (11.3) | 1.32 (0.82 to 2.12) | 0.19 | 1.39 (0.85 to 2.28) | |
| ≥52 weeks before death | 133 (32.8) | 1 | . | 1 | |
| Very frequent attenders | |||||
| (≥10 attendances per year) | Time between diagnosis and death | ||||
| (n=108 cancer decedents) | 0–12 weeks before death | 24 (22.2) | 0.47 (0.27 to 0.81) | 0.02 | 0.48 (0.27 to 0.87) |
| 13–25 weeks before death | 16 (14.8) | 1.03 (0.54 to 1.97) | 0.82 | 1.08 (0.55 to 2.13) | |
| 26–38 weeks before death | 16 (14.8) | 1.64 (0.54 to 1.97) | 0.11 | 1.78 (0.89 to 3.57) | |
| 39–51 weeks before death | 14 (13.0) | 1.41 (0.70 to 2.83) | 0.21 | 1.58 (0.77 to 3.23) | |
| ≥52 weeks before death | 38 (35.2) | 1 | . | 1 | |
| Attendance level analysis: (reference category = attendances by infrequent attenders (n=2928 unscheduled care attendances)) | |||||||
| Attendances by all cancer decedents | Attendance level factors | All cancer decedents (n=6914 attendances) (%) | Infrequent attenders (n=2928 attendances) (%) | Frequent and very frequent attenders (n=3986 attendances) (%) | Univariate: unadjusted Wald OR (95% CI) | Wald p value (adj) | Multivariate: adjusted Wald OR (95% CI) |
| Attendances by all cancer decedents | Type of unscheduled care | ||||||
| (n=6,914 unscheduled care attendances in the last year of life) | A&E | 1463 (21.2) | 656 (22.4) | 509 (12.8) | 0.51 (0.45 to 0.58) | <0.001 | 0.69 (0.59 to 0.82) |
| GPOOH (ref) | 5451 (78.8) | 2272 (77.6) | 3477 (87.2) | 1 | – | 1 | |
| Presenting complaint | |||||||
| Pain | 818 (11.8) | 388 (13.3) | 430 (10.8) | 0.71 (0.61 to 0.83) | 0.54 | 1.06 (0.89 to 1.25) | |
| Unwell and palliative care | 1325 (19.2) | 563 (19.2) | 762 (19.1) | 0.87 (0.77 to 0.99) | 0.91 | 1.01 (0.88 to 1.16) | |
| Breathlessness | 248 (3.6) | 120 (4.1) | 128 (3.2) | 0.69 (0.53 to 0.89) | 0.3§ | 1.16 (0.87 to 1.53) | |
| GI symptoms | 358 (5.2) | 165 (5.6) | 193 (4.8) | 0.75 (0.61 to 0.94) | 0.59 | 0.94 (0.75 to 1.18) | |
| Infection | 591 (8.5) | 248 (8.5) | 343 (8.6) | 0.89 (0.75 to 1.06) | 0.28 | 1.11 (0.92 to 1.34) | |
| Acute neurological Sympt. | 214 (3.1) | 128 (4.4) | 86 (2.2) | 0.43 (0.33 to 0.57) | 0.1 | 0.77 (0.57 to 1.05) | |
| Missing or other (ref) | 3360 (48.6) | 1316 (44.9) | 2044 (51.3) | 1 | – | 1 | |
| Clinical priority | |||||||
| Highest clinical priority* | 569 (8.2) | 263 (9.0) | 306 (7.7) | 0.86 (0.72 to 1.03) | 0.04 | 1.23 (1.01 to 1.50) | |
| Middle clinical priority | 2467 (35.7) | 1015 (34.7) | 1452 (36.4) | 1.06 (0.96 to 1.17) | <0.001 | 1.31 (1.17 to 1.46) | |
| Lowest clinical priority (ref) | 3878 (56.1) | 1650 (56.4) | 2228 (55.9) | 1 | – | 1 | |
| Attendance type | |||||||
| GP visit or ambulance | 3724 (53.9) | 1715 (58.6) | 2009 (50.4) | 0.61 (0.55 to 0.68) | 0.002 | 0.81 (0.71 to 0.93) | |
| In-person attendance | 721 (10.4) | 370 (12.6) | 351 (8.8) | 0.49 (0.41 to 0.58) | <0.001 | 0.69 (0.56 to 0.84) | |
| Other (ref) | 2469 (35.7) | 843 (28.8) | 1626 (40.8) | 1 | – | 1 | |
| Outcomes of attendance | |||||||
| GP follow-up | 2315 (33.5) | 1019 (34.8) | 2315 (33.5) | 0.76 (0.67 to 0.86) | <0.001 | 0.75 (0.66 to 0.86) | |
| Admitted to hospital | 1408 (20.4) | 773 (26.4) | 1408 (20.4) | 0.49 (0.42 to 0.56) | <0.001 | 0.55 (0.46 to 0.65) | |
| Passed to another clinician | 193 (2.8) | 78 (2.7) | 193 (2.8) | 0.88 (0.65 to 1.19) | 0.98 | 1.01 (0.74 to 1.37) | |
| Missing or other | 1260 (18.2) | 410 (14.0) | 1260 (18.2) | 1.23 (1.06 to 1.44) | 0.55 | 1.05 (0.89 to 1.25) | |
| No follow-up (ref) | 1738 (25.1) | 648 (22.1) | 1738 (25.1) | 1 | – | 1 | |
Rurality: ‘Urban’ comprises SEUR1&2, ‘Accessible’ comprises SEUR3&5 and ‘Remote’ comprises SEUR 4 & 6. 33 people had missing data. Deprivation: Scottish Index of Multiple Deprivation (SIMD). Category 1 is most deprived, and category 5 is least deprived. Missing data: 33 people in the cohort had missing SEUR and SIMD data and were omitted fro the rurality and deprivation section of the regression analysis.
*Highest clinical priority: GPOOH ‘emergency’; A&E ‘resuscitation’. Middle clinical priority: GPOOD ‘urgent’ and A&E ‘majors’. Lowest clinical priority: GPOOH ‘routine’ and A&E ‘minors’.
A&E, accident and emergency; GI, gastrointestinal; GPOOH, general practice out of hours; SEUR, Scottish Executive Urban Rural Classification; SIMD, Scottish Index of Multiple Deprivation.