Equitable access to palliative care services for people ...

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In 2015, the number of registered deaths in Northern Ireland (NI) increased compared to previous ... Public Health Agency & Health & Social Care Board (2018).

Equitable access to palliative care services for people with dementia: Feasibility of identification using the AnticiPAL algorithm Corrina Grimes, MSc1,2 ; Paul Turley3 ; Dominic Trépel, PhD1 1 Trinity

College Dublin, 2 Public Heath Agency, Northern Ireland 3Health and Social Care Board , Northern Ireland

Background

Identification of Palliative Care Need in Northern Ireland

Palliative care need in the population are under identified and the annual incidence of deaths

In 2017, Pubic Health Agency identified 341 General Practices (GP) with a palliative care

as the single most important predictor of the level of demand that arise in the last years of life .

register and find that the average GP practice size was 5,500 registered patients. It is

In 2015, the number of registered deaths in Northern Ireland (NI) increased compared to

estimated that, at any one time, 1% of the population could benefit from a palliative care

previous years and this increase has been demonstrated globally1.

approach. Using the register to proxy of identified need, it could be assumed that the patient numbers on a GP palliative care register should reflect 1% of the registered population of that practice. In 2017, most practices are under identifying these patients and our data suggests only 3% of practices in the palliative care registers were identifying between 0.76 – 1% who could benefit from a palliative care approach6.

Deaths due to mental and behavioural disorders more than tripled which represented the largest reason underlying this increase in deaths. This increase has been primarily driven by a growth in deaths due to unspecified dementia2. Historically palliative care has been most associated with cancer or with needs of individuals

Study Aim

in the last few week or days of life. However, initiating palliative care late represents a missed opportunity for services to improve quality of life for those at the end of life, those important to

To carry out a feasibility study to determine the feasibility and acceptability of using a

them, and health services. In high income countries, up to 80% of people who die could

computer application (AnticiPal) to improve identification of people who may benefit from

benefit from palliative care much earlier in their illness3.

a palliative care approach in General Practice within Northern Ireland.

Clinical tools are available to help assist the identification of individuals that might benefit from

Objectives are to:

a palliative care approach and Supportive Palliative Care Indicators Tool ( SPICT ) is one which includes indicators for dementia. SPICT is in use in every continent and is currently available in English, French, German, Dutch, Spanish and Portuguese languages. The use of

• Increase the number of people identified who would met the criteria for inclusion on the GP Palliative Care register for those practices using the protocol in the test period compared current usual care.

SPICT™ suggests a GP with 2,000 patients should expect around seven deaths from dementia or frailty, six from organ failure such as COPD or heart failure, and five from cancer4.

• To gain consensus from General Practitioners on the acceptability of “AnticiPal” to identify Palliative Care needs for those with Dementia.

Study Method The Palliative Care in Partnership Programme, will be recruiting between 14 – 20 GP practices to run the “AnticiPAL” within their clinical system, monthly for a six months. Augmenting this initiative, this feasibility study will apply a mixed methods approach to examine AnticiPAL role in dementia. We will employ data analysis, action research through Co- operative Inquiry and a Delphi study. Data analysis will exploit approximately 82,500 patients records and will generate a practice level list of patients to be discussed at the Primary Care Multidisciplinary team ( MDT). The MDT in association with the patient and care givers will plan care as deemed appropriate. GP practice have agreed to provide data on a monthly bases. The researcher will observe a sample of the MDT meetings to identify any key themes. A Delphi study will be carried out to gain consensus on the acceptability of “AnticiPAL” in identifying palliative care need for those with dementia. Further work will also be explored to access patient level date for further analysis. The The Palliative Care Early Identification Feasibility study is being implemented using an established computerised search based on SPICT™ in primary care GP Clinical systems5.

finding of this study will be used to determine if this approach should be scaled across other GP practices in Northern Ireland to support the identification of palliative care need.

This search algorithm has already been developed, piloted and modified by the University of Edinburgh and Marie Curie, called “AnticiPAL” and uses a list of Read code which singularly or in combination might indicate a person has deteriorating health and palliative care needs, for a range of condition including dementia.

References 1.Etkind,

S. N., Bone, A. E., Gomes, B., Lovell, N., Evans, C. J., Higginson, I. J., & Murtagh, F. E. M. (2017). How many people will need palliative care in 2040? Past trends, future projections and implications for services. BMC Medicine, 15(1). http://doi.org/10.1186/s12916-017-0860-2 2. Public Health Agency & Health & Social Care Board (2018). Palliative Care Needs Assessment; Phase 1 3. Murray, S. A., Kendall, M., Mitchell, G., Moine, S., Amblàs-Novellas, J., & Boyd, K. (2017). Palliative care from diagnosis to death. BMJ (Online). http://doi.org/10.1136/bmj.j878 4. Accessed 11 March 2018 https://www.spict.org.uk/using-the-spict-tool-extract-from-pulse/ 5. Mason, B., Boyd, K., Steyn, J., Kendall, M., Macpherson, S., & Murray, S. A. (2018). Computer screening for palliative care needs in primary care: a mixed-methods study. British Journal of General Practice. 6.Accessed 11 March https://www.health-ni.gov.uk/news/northern-ireland-quality-and-outcomes-framework-qofinformation-201617

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