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Palliative care for non-cancer conditions in primary care: a time trend analysis in the UK (2009–2014)

Gadoud, Amy; Kane, Eleanor; Oliver, Steven Edward; Johnson, Miriam J; Macleod, Una; Allgar, Victoria

Authors

Amy Gadoud

Eleanor Kane

Steven Edward Oliver

Victoria Allgar



Abstract

Objectives While guidelines recommend palliative care in non-cancer conditions, this has not been widely implemented. We examined whether the recording of a palliative care approach and the numbers of hospital deaths for deceased patients with heart failure, dementia, chronic obstructive pulmonary disease (COPD) and cancer have changed since the UK End-of-Life Care Strategy was introduced.

Methods We conducted sequential cross-sectional studies of decedents within the UK’s Clinical Practice Research Datalink and Hospital Episode Statistics. All adults with a primary care record of COPD (n=5426), dementia (n=7339), heart failure (n=6409) or cancer (n=18 668) who died during three 1 year periods (April 2009 to March 2014) were included. Evidence of a palliative care approach was identified from primary care records, and death in hospital from secondary care data.

Results From 2009 to 2014, proportions with a primary care record of palliative care increased for COPD from 13.6% to 21.2%; dementia from 20.9% to 40.7%; and heart failure from 12.6% to 21.2%; but remained substantially lower than for cancer (57.6% to 61.9%). Median days before death of recording improved for COPD (145 to 224) and dementia (44 to 209); but not for heart failure (168.5 to 153) and cancer (123 to 114). Trends in hospital deaths were not consistently downward, although the proportions of patients dying in hospital were lower in the last period compared with the first.

Conclusions Recording of a palliative care approach for non-cancer conditions has increased since the introduction of the UK End-of-Life Care Strategy, but remains inadequate.

Citation

Gadoud, A., Kane, E., Oliver, S. E., Johnson, M. J., Macleod, U., & Allgar, V. (in press). Palliative care for non-cancer conditions in primary care: a time trend analysis in the UK (2009–2014). BMJ supportive & palliative care, https://doi.org/10.1136/bmjspcare-2019-001833

Journal Article Type Article
Acceptance Date Dec 16, 2019
Online Publication Date Jan 13, 2020
Deposit Date Apr 23, 2020
Publicly Available Date May 4, 2020
Journal BMJ Supportive & Palliative Care
Print ISSN 2045-435X
Electronic ISSN 2045-4368
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Article Number 001833
DOI https://doi.org/10.1136/bmjspcare-2019-001833
Keywords Primary Health Care; Palliative Care; Neoplasms; Chronic obstructive pulmonary disease; Heart failure; Dementia
Public URL https://hull-repository.worktribe.com/output/3497294
Publisher URL https://spcare.bmj.com/content/early/2020/01/13/bmjspcare-2019-001833
Related Public URLs https://eprints.lancs.ac.uk/id/eprint/141153

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Publisher Licence URL
http://creativecommons.org/licenses/by-nc/4.0

Copyright Statement
©2020 The authors. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder





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