Given that this service is offering support to such a significant proportion of patients at the end of life, additional resources for this work, together with improved communication between in hours and OOH GPs, could help ensure that people at the end of life receive care in their preferred setting.
- Dr Gail Hayward, University of Oxford
Out-of-hours GPs see almost one third of people who die in Oxfordshire, according to a new study published in the journal BMJ Open.
This is the first study in the UK to look at the extent to which Out-of-Hours (OOH) GP services play a role in end-of-life care. The team of researchers, a collaboration between Oxford University, Birmingham University and Oxford Health NHS Foundation Trust, found that almost one third of all people who die in Oxfordshire contact out-of-hours care in the 30 days leading up to their death.
Study lead Dr Gail Hayward, an Oxford-based GP and Academic Clinical Lecturer in Oxford University’s Nuffield Department of Primary Care Health Sciences, said: “Many patients with a terminal illness wish to die at home rather than in hospital. It is important that our patients receive the best possible access to care at the end of their life, regardless of the time of day or night they make the call for support. This study demonstrates the important role Oxfordshire’s OOH GP services play in end-of-life care.
"Given that this service is offering support to such a significant proportion of patients at the end of life, additional resources for this work, together with improved communication between in hours and OOH GPs, could help ensure that people at the end of life receive care in their preferred setting.”
The researchers examined anonymised patient medical records during a 12-month period in 2014/15, to understand how Oxfordshire’s Out-Of-Hours Service provided end of life care. The researchers were also interested in whether there were any differences in care for patients documented as being at the end of life, which comprised just over a third of the total (36%) compared with those that were not documented as such, but were within 30 days of death.
The study found that patients documented as needing palliative care were seen more frequently, were more likely to be assessed at home and less likely to be admitted to hospital or managed through telephone contact. Most palliative care patients died from cancer (70%), while only 30% of patients not documented as palliative died from the illness.
Commenting on this discrepancy, Dr Hayward said: “There will of course be patients for whom an acute life-threatening syndrome led to an out-of-hours contact, and clinicians may also recognise patients to be at the end of life but record alternative clinical problems in the medical notes. Further research is needed to understand whether improving recognition of the end of life in older people with frailty might alter shared decisions with patients and carers about hospital admission compared with care at home.
Across Oxfordshire, the Out-Of-Hours Service provides urgent medical care from 6:30pm to 8:00am during the week, with 24-hour cover provided at weekends and bank holidays. In 2017/18, 110,000 patients made 145,000 contacts with the service.
What proportion of patients at the end of life contact out-of-hours primary care? A data linkage study in Oxfordshire. Rachel Brettell, Rebecca Fisher, Helen Hunt, Sophie Garland, Daniel Lasserson, Gail Hayward. BMJ Open 2018;0:e020244 http://dx.doi.org/10.1136/bmjopen-2017-020244