Association between primary care contacts, continuity of care and identification of palliative care needs with hospital utilization among people dying with dementia: a population-based cohort study

Abstract

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 and identification of palliative care needs with unplanned hospital admissions among people dying with dementia. Design & setting: Retrospective cohort study using the Clinical Practice Research Datalink linked with hospital records and Office for National Statistics data. Adults (>18 years) who died between 2009-2018 with a diagnosis of dementia. Methods: We evaluated associations between GP contacts, the Herfindahl Hirschman continuity of care (CoC) score and palliative care needs identification before the last 90 days of life with multiple unplanned hospital admissions in the last 90 days using random-effects Poisson regression. Results: We identified 33714 decedents with dementia: 64.1% female, mean age 86.6 (SD 8.1), mean comorbidities 2.2 (SD 1.6). 1894 (5.6%) had multiple hospital admissions in the last 90 days of life (increase from 4.9% (95% CI 4.2-5.6) in 2009 to 7.1% (95% CI 5.7-8.4) in 2018). Participants with more GP contacts had higher risk of multiple hospital admissions (IRR 1.08, 95% CI 1.05-1.11). Higher CoC scores (IRR 0.79, 95% CI 0.68-0.92) and identification of palliative care needs (IRR 0.66, 95% CI 0.56-0.78) were associated with lower frequency of these admissions. Conclusions: Multiple hospital admissions among people dying with dementia are increasing. Higher CoC 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.