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Research

Timing of GP end-of-life recognition in people aged ≥75 years: retrospective cohort study using data from primary healthcare records in England

Daniel Stow, Fiona E Matthews and Barbara Hanratty
British Journal of General Practice 2020; 70 (701): e874-e879. DOI: https://doi.org/10.3399/bjgp20X713417
Daniel Stow
Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
Roles: Research associate
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Fiona E Matthews
Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
Roles: Professor of epidemiology
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Barbara Hanratty
Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
Roles: Professor of primary care and public health
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Abstract

Background High-quality, personalised palliative care should be available to all, but timely recognition of end of life may be a barrier to end-of-life care for older people.

Aim To investigate the timing of end-of-life recognition, palliative registration, and the recording of end-of-life preferences in primary care for people aged ≥75 years.

Design and setting Retrospective cohort study using national primary care record data, covering 34% of GP practices in England.

Method ResearchOne data from electronic healthcare records (EHRs) of people aged ≥75 years who died in England between 1 January 2015 and 1 January 2016 were examined. Clinical codes relating to end-of-life recognition, palliative registration, and end-of-life preferences were extracted, and the number of months that elapsed between the code being entered and death taking place were calculated. The timing for each outcome and proportion of relevant EHRs were reported.

Results Death was recorded for a total of 13 149 people in ResearchOne data during the 1-year study window. Of those, 6303 (47.9%) records contained codes suggesting end of life had been recognised at a point in time prior to the month of death. Recognition occurred ≥12 months before death in 2248 (17.1%) records. In total, 1659 (12.6%) people were on the palliative care register and 457 (3.5%) were on the register for ≥12 months before death; 2987 (22.7%) records had a code for the patient’s preferred place of care, and 1713 (13.0%) had a code for the preferred place of death. Where preferences for place of death were recorded, a care, nursing, or residential home (n = 813, 47.5%) and the individual’s home (n = 752, 43.9%) were the most common.

Conclusion End-of-life recognition in primary care appears to occur near to death and for only a minority of people aged ≥75 years. The findings suggest that older people’s deaths may not be anticipated by health professionals, compromising equitable access to palliative care.

  • coding
  • end of life
  • palliative care
  • primary care
  • prognostication
  • Received February 26, 2020.
  • Revision requested April 20, 2020.
  • Accepted May 17, 2020.
  • © British Journal of General Practice 2020
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British Journal of General Practice: 70 (701)
British Journal of General Practice
Vol. 70, Issue 701
December 2020
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Timing of GP end-of-life recognition in people aged ≥75 years: retrospective cohort study using data from primary healthcare records in England
Daniel Stow, Fiona E Matthews, Barbara Hanratty
British Journal of General Practice 2020; 70 (701): e874-e879. DOI: 10.3399/bjgp20X713417

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Timing of GP end-of-life recognition in people aged ≥75 years: retrospective cohort study using data from primary healthcare records in England
Daniel Stow, Fiona E Matthews, Barbara Hanratty
British Journal of General Practice 2020; 70 (701): e874-e879. DOI: 10.3399/bjgp20X713417
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Keywords

  • coding
  • end of life
  • palliative care
  • primary care
  • prognostication

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