Practices deliver good end of life care for dementia

Source: Practice Index

People dying with dementia have reduced need to go to hospital at the end of life if they have good continuity of care at home, according to a UK study published today.

The study by King’s College London, published in the British Journal of General Practice, says transitions to hospital are distressing for patients and their families and are associated with negative outcomes.

Between 9% and 20% of people dying with dementia have some transition of care in the last three months of life and this retrospective cohort study used a nationally representative sample of GP practices in England.

Using random-effects Poisson regression, they evaluated the association between GP contacts, the Herfindahl–Hirschman Index continuity of care score, palliative care needs identified before the last 90 days of life, and multiple unplanned hospital admissions in the last 90 days.

The team identified 33,714 individuals who died from dementia were identified, of whom 64.1% (21,623) were female and with a mean age of 86.6 years.

Of these, 1,894 (5.6%) had multiple hospital admissions in the last 90 days of life and those with more GP contacts had higher risk of multiple hospital admissions.

However, higher continuity of care scores and identification of palliative care needs were associated with lower frequency of these admissions.

Lead author Dr Javiera Leniz Martelli said: “People with dementia living at home with better continuity of care with GPs, and those whose palliative care needs have been identified in primary care are less likely to have transitions to hospital at the end of life.”

The authors say their findings are important because improving the level of continuity of care and identifying palliative care needs in general practices could help to reduce unnecessary and burdensome transitions to hospital.

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