Is it possible and worth keeping track of deaths within general practice? Results of a 15 year observational study

Supporting bereavement and complicated grief in primary care: a realist review

Background

Bereavement can have significant impacts on physical and mental health, and a minority of people experience complicated and prolonged grief responses. Primary care is ideally situated to offer bereavement care, yet UK provision remains variable and practitioners feel uncertain how best to support bereaved patients.

Aim

To identify what works, how, and for whom, in the management of complicated grief (CG) in primary care.

Design & setting

A review of evidence on the management of CG and bereavement in UK primary care settings.

Method

A realist approach was taken that aims to provide causal explanations through the generation and articulation of contexts, mechanisms, and outcomes.

Results

Forty-two articles were included. Evidence on the primary care management of complicated or prolonged grief was limited. GPs and nurses view bereavement support as part of their role, yet experience uncertainty over the appropriate extent of their involvement. Patients and clinicians often have differing views on the role of primary care in bereavement. Training in bereavement, local systems for reporting deaths, practitioner time, and resources can assist or hinder bereavement care provision. Practitioners find bereavement care can be emotionally challenging. Understanding patients’ needs can encourage a proactive response and help identify appropriate support.

Conclusion

Bereavement care in primary care remains variable and practitioners feel unprepared to provide appropriate bereavement care. Patients at higher risk of complicated or prolonged grief may fail to receive the support they need from primary care. Further research is required to address the potential unmet needs of bereaved patients.

Validation of death and suicide recording on the THIN UK primary care database

PURPOSE

Data from a cohort study were used to investigate death and cause of death (COD) recording on the THIN UK primary care database.

METHODS

Subjects from 118 practices had a body mass index recorded, 2002-2003 (index date), no recent pregnancy or emotional event, or cancer. Coded and free text entries were searched for a COD for deaths dated < or = 485 days after index date. External documents were requested when date or COD were unclear, suicide was possible, and for a random sample of 40 patients with a COD identified.

RESULTS

Five of 1399 deaths dated within 1 year of the index date had not died (positive predictive value 99.6%) and 4 of 222 dated within 366-485 days had died during the year (sensitivity 99.7%). A database COD was identified for 887 (63.4%) with external documents received for 597 (92.8% requested). Of 40 compared with external sources, the underlying COD was on the database in 33 (82.5%), and could be identified as such in 26 (65%). The date was within 1 day of that on external documents in 504 (94.9%) with a date of death but 3 (5.7%) with only a transfer-out of practice date. One of seven suicides was recorded as such.

CONCLUSION

Any database record of death or its date is reliable, but transfer-out date is often later. Studies of COD or acute, potentially fatal conditions will miss cases unless a COD is obtained for all fatalities. Most suicides are not noted as such on the electronic record.

Making use of mortality data to improve quality and safety in general practice: a review of current approaches

OBJECTIVE

To review studies of the use of mortality data in quality and safety improvement in general practice.

DESIGN

Narrative review.

METHODS

Search of Medline, Embase and CINAHL for articles reporting mortality monitoring or mortality reviews in general practice. The included articles were reported in English and of any study design, excluding case reports and comment pieces. Studies of palliative care and bereavement, and of primary care programmes in developing countries, were excluded.

RESULTS

229 articles were identified in the searches, 65 were identified as potentially relevant and 53 were included in the review. The studies addressed the impact of primary care provision on mortality rates, methods of monitoring mortality, and the role of audit and death registers in quality and safety improvement. General practitioners were interested in using mortality data but reported difficulties in obtaining complete information. There were no experimental studies of the impact of the use of mortality data, and little evidence of long-term systematic initiatives to use mortality data in quality and safety improvement in general practice.

CONCLUSIONS

Mortality data are not used systematically in general practice although general practitioners appear interested in the potential of this information in improving quality and safety. Improved systems to provide complete data are needed and experimental studies required to determine the effectiveness of use of the data to improve general practice care.