More anticipatory care advocated for older patients with
co-morbidity
25/01/12
The management of end of life care,
particularly for patients suffering from more than one medical
condition (co-morbidity), could be addressed by GPs having
anticipatory care plan discussions with patients, suggests a study
in this month’s British Journal of General Practice (BJGP).
ACPs allow discussion between patients, professional carers and
sometimes family and friends, to ensure patients’ wishes regarding
their final stages of care are widely known. An advanced
directive, or living will can then be drawn up, setting out
patients’ wishes in the event of a sudden deterioration in health,
which may include decisions such as 'do not resuscitate'.
The authors of the study, have found that more use of ACPs in
primary care helped reduce unplanned hospitalisation by 52 per
cent as more was understood regarding patients wishes
surrounding medical interventions. ACPs did not affect the
number of deaths of patients who took part in the study, compared
to the control group, but the number of patients who died in
hospital and the hospital bed days used in the last three months of
life were significantly lower for decedents with an ACP, saving
those patients from medical procedures they may not have wished to
endure.
Dr Adrian Baker, a GP in Nairn, Scotland, who led the study,
said: "Today’s NHS is all about patient choice, but few patients
seem to understand the choices available to them in their final few
months. Anticipatory care plans are a good way of looking at
the options available with a view to ensuring that the wishes of
loved ones are fully understood by everyone involved in their care
so that unplanned hospitalisation can be avoided.
“We are faced with an ageing population, which is estimated to
see 22 per cent of the population aged over 65 years by 2035.
GPs have knowledge of a patient’s full medical history and often
have a relationship based on trust. They are uniquely placed
to broach this issue with the patient to help ensure their final
wishes are met.”
Editor of the BJGP, Professor Roger Jones, added: "As the
population ages and multimorbidity becomes an increasing problem,
planned management, including the management of terminal illness,
is increasingly required. This study helps to emphasise the
importance and benefits of this approach, and identifies some of
the key ingredients of integrated, anticipatory planning in primary
care."
Also in this issue of the BJGP:
- Dementia care still needs to be improved. In an analysis
of the annual dementia review in over 50 general practice in
greater Manchester, Amanda Connolly and colleagues found that in
over one third of cases there had been no discussion with
carers and in half no review of social care. There was also
evidence of inappropriate prescribing and monitoring of
anti-psychotic medication. Standards of care were higher in
larger general practices.
- Air travel can be hazardous for patients with COPD
(Chronic Obstrucive Pulmonary Disease). Commenting on a case
study of a female smoker with COPD who became severely breathless
on a flight from Athens to Amsterdam, Ionna Tsiligianni and
colleagues point out that of the 2 billion air travellers
each year as many as one in five adults may have COPD, and
may well experience problems requiring in-flight oxygen
administration. The European Lung Foundation has created a database
of information on oxygen policies for over 300 airlines
(www.european-lung-foundation.org).
ENDS
Further information
RCGP Press office: 020 3188 7576/7575/7574/7569
Out of hours Duty Press Officer: 020 3188 7659
press@rcgp.org.uk
Notes to editors
Anticipatory care planning and integration: a primary care pilot
study aimed at reducing unplanned hospitalisation. Br J Gen Pract
2012; DOI 10.3399/bjgp12X625175. Baker A, Leak P, Ritchie LD, Lee
AJ, Fielding S.
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