The British journal of general practice: the journal of the Royal College of General Practitioners | |
Primary care contacts, continuity, identification of palliative care needs, and hospital use: a population-based cohort study in people dying with dementia | |
article | |
Wei Gao1  Katherine E Sleeman1  Javiera Leniz1  Martin Gulliford2  Irene J Higginson1  Sabrina Bajwah1  Deokhee Yi1  | |
[1] NIHR clinician scientist and honorary consultant in palliative medicine, Cicely Saunders Institute for Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London;Department of Population Health Sciences, Faculty of Life Science & Medicine, King’s College London | |
关键词: dementia; end of life; family practice; palliative care; primary health care; hospitalisation; | |
DOI : 10.3399/BJGP.2021.0715 | |
学科分类:卫生学 | |
来源: Royal College of General Practitioners | |
【 摘 要 】
Background Reducing hospital admissions among people dying with dementia is a policy priority.Aim To explore associations between primary care contacts, continuity of primary care, identification of palliative care needs, and unplanned hospital admissions among people dying with dementia.Design and setting18 years) who died between 2009 and 2018 with a diagnosis of dementia were included in the study.Method The association between GP contacts, Herfindahl–Hirschman Index continuity of care score, palliative care needs identification before the last 90 days of life, and multiple unplanned hospital admissions in the last 90 days was evaluated using random-effects Poisson regression.Results In total, 33 714 decedents with dementia were identified: 64.1% (n = 21 623) female, mean age 86.6 years (SD 8.1), mean comorbidities 2.2 (SD 1.6). Of these, 1894 (5.6%) had multiple hospital admissions in the last 90 days of life (increase from 4.9%, 95% confidence interval [CI] = 4.2 to 5.6 in 2009 to 7.1%, 95% CI = 5.7 to 8.4 in 2018). Participants with more GP contacts had higher risk of multiple hospital admissions (incidence risk ratio [IRR] 1.08, 95% CI = 1.05 to 1.11). Higher continuity of care scores (IRR 0.79, 95% CI = 0.68 to 0.92) and identification of palliative care needs (IRR 0.66, 95% CI = 0.56 to 0.78) were associated with lower frequency of these admissions.Conclusion Multiple hospital admissions among people dying with dementia are increasing. Higher continuity of care and identification of palliative care needs are associated with a lower risk of multiple hospital admissions in this population, and might help prevent these admissions at the end of life.
【 授权许可】
Free
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