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Mills SE, Brown-Kerr A, Buchanan D, Donnan PT, Smith BH. Free-text analysis of general practice out-of-hours (GPOOH) use by people with advanced cancer: an analysis of coded and uncoded free-text data. Br J Gen Pract 2023; 73:e124-e132. [PMID: 36702608 PMCID: PMC9888572 DOI: 10.3399/bjgp.2022.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 10/06/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND People with advanced cancer frequently use the GP out-of-hours (GPOOH) service. Considerable amounts of routine GPOOH data are uncoded. Therefore, these data are omitted from existing healthcare datasets. AIM To conduct a free-text analysis of a GPOOH dataset, to identify reasons for attendance and care delivered through GPOOH to people with advanced cancer. DESIGN AND SETTING An analysis of a GPOOH healthcare dataset was undertaken. It contained all coded and free- text information for 5749 attendances from a cohort of 2443 people who died from cancer in Tayside, Scotland, from 2013-2015. METHOD Random sampling methods selected 575 consultations for free-text analysis. Each consultation was analysed by two independent reviewers to determine the following: assigned presenting complaints; key and additional palliative care symptoms recorded in free text; evidence of anticipatory care planning; and free-text recording of dispensed medications. Inter-rater reliability concordance was established through Kappa testing. RESULTS More than half of all coded reasons for attendance (n = 293; 51.0%) were 'other' or 'missing'. Free-text analysis demonstrated that nearly half (n = 284; 49.4%) of GPOOH attendances by people with advanced cancer were for pain or palliative care. More than half of GPOOH attendances (n = 325; 56.5%) recorded at least one key or additional palliative care symptom in free text, with the commonest being breathlessness, vomiting, cough, and nausea. Anticipatory care planning was poorly recorded in both coded and uncoded records. Uncoded medications were dispensed in more than one- quarter of GPOOH consultations. CONCLUSION GPOOH delivers a substantial amount of pain management and palliative care, much of which is uncoded. Therefore, it is unrecognised and under-reported in existing large healthcare data analyses.
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Affiliation(s)
- Sarah Ee Mills
- School of Medicine, University of St Andrews, St Andrews
| | | | | | - Peter T Donnan
- Population Health and Genomics Division, University of Dundee Medical School, Ninewells Hospital and Medical School, Dundee
| | - Blair H Smith
- Population Health and Genomics Division, University of Dundee Medical School, Ninewells Hospital and Medical School, Dundee
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Mills SEE, Buchanan D, Donnan PT, Smith BH. Community prescribing trends and prevalence in the last year of life, for people who die from cancer. BMC Palliat Care 2022; 21:120. [PMID: 35799225 PMCID: PMC9264643 DOI: 10.1186/s12904-022-00996-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background People who die from cancer (‘cancer decedents’) may latterly experience unpleasant and distressing symptoms. Prescribing medication for pain and symptom control is essential for good-quality palliative care; however, such provision is variable, difficult to quantify and poorly characterised in current literature. This study aims to characterise trends in prescribing analgesia, non-analgesic palliative care medication and non-palliative medications, to cancer decedents, in their last year of life, and to assess any associations with demographic or clinical factors. Methods This descriptive study, analysed all 181,247 prescriptions issued to a study population of 2443 cancer decedents in Tayside, Scotland (2013–2015), in the last year of life, linking prescribing data to demographic, and cancer registry datasets using the unique patient-identifying Community Health Index (CHI) number. Anonymised linked data were analysed in Safe Haven using chi-squared test for trend, binary logistic regression and Poisson regression in SPSSv25. Results In their last year of life, three in four cancer decedents were prescribed strong opioids. Two-thirds of those prescribed opioids were also prescribed laxatives and/or anti-emetics. Only four in ten cancer decedents were prescribed all medications in the ‘Just in Case’ medication categories and only one in ten was prescribed breakthrough analgesia in the last year of life. The number of prescriptions for analgesia and palliative care drugs increased in the last 12 weeks of life. The number of prescriptions for non-palliative care medications, including anti-hypertensives, statins and bone protection, decreased over the last year, but was still substantial. Cancer decedents who were female, younger, or had lung cancer were more likely to be prescribed strong opioids; however, male cancer decedents had higher odds of being prescribed breakthrough analgesia. Cancer decedents who had late diagnoses had lower odds of being prescribed strong opioids. Conclusions A substantial proportion of cancer decedents were not prescribed strong opioids, breakthrough medication, or medication to alleviate common palliative care symptoms (including ‘Just in Case’ medication). Many patients continued to be prescribed non-palliative care medications in their last days and weeks of life. Age, gender, cancer type and timing of diagnosis affected patients’ odds of being prescribed analgesic and non-analgesic palliative care medication. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00996-3.
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Affiliation(s)
- Sarah E E Mills
- University of St Andrews, School of Medicine, North Haugh, St Andrews, KY16 9TF, UK.
| | - Deans Buchanan
- NHS Tayside, South Block, Level 7, Ninewells Hospital, DD2 4BF, Dundee, Scotland
| | - Peter T Donnan
- Population Health and Genomics Division, University of Dundee Medical School Mackenzie Building, Ninewells Hospital and Medical School, Kirsty Semple Way, Dundee, DD2 4BF, Scotland
| | - Blair H Smith
- Population Health and Genomics Division, University of Dundee Medical School Mackenzie Building, Ninewells Hospital and Medical School, Kirsty Semple Way, Dundee, DD2 4BF, Scotland
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Medical Utilization of Emergency Departments among Patients with Prostate Cancer: A Nationwide Population-Based Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413233. [PMID: 34948836 PMCID: PMC8701110 DOI: 10.3390/ijerph182413233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/26/2021] [Accepted: 12/13/2021] [Indexed: 11/17/2022]
Abstract
(1) Background: In Taiwan, prostate cancer is a major malignancy with an increasing incidence among men. This study explores the medical utilization of emergency departments among patients with prostate cancer in Taiwan. (2) Methods: This nationwide, population-based study was conducted via a cross-sectional method based on the Registry for Catastrophic Illness Patient Database from Taiwan’s National Health Insurance Research Database. Patients with newly diagnosed prostate cancer between 1997 and 2013 were enrolled in the study and divided into four treatment-related groups. The rate of emergency department presentation, disease categorization of emergency department visits, emergency department-related medical expenditures, and temporal trends were investigated. (3) Results: A total of 18,728 patients with prostate cancer were identified between 1997 and 2013, for whom 13,098 emergency department visits were recorded. The number of emergency department visits increased during the study period. The incidence rate for the medical utilization of emergency department visits was 822 per 1000 people during the study period. The incidence rates for patients with prostate cancer in the radical prostatectomy, radiotherapy, androgen deprivation therapy, and chemotherapy groups were 549, 1611, 1101, and 372, respectively. The average medical expenditure per emergency department visit was TWD 3779.8 ± 5116.2, and the expenditure was recorded for the chemotherapy group at TWD 4690.8 ± 7043.3. The most common disease diagnoses among patients with prostate cancer who presented to the emergency department were injury/poisoning (16.79%), genitourinary disorders (10.66%), and digestive disorders (10.48%). (4) Conclusions: This nationwide population-based study examined the emergency department visits of patients with prostate cancer in Taiwan, providing useful information for improving the quality of medical care.
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Abdel-Rahman O. Gender, socioeconomic status and emergency department visits among cancer survivors in the USA: a population-based study. J Comp Eff Res 2021; 10:969-977. [PMID: 34156279 DOI: 10.2217/cer-2020-0278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To assess patterns of emergency department visits and subsequent hospitalization in relation to gender and socioeconomic status among a cohort of cancer survivors in the USA. Materials & methods: National Health Interview Survey datasets (2011-2017) were reviewed and participants with a history of cancer and complete information about emergency department visits in the past 12 months were included. Multivariable logistic regression analyses were used to assess factors associated with emergency department visits and subsequent hospitalization after the most recent emergency department visit. Results: A total of 22,240 cancer survivors were included in the current analysis; of which 16,133 participants (72.5%) who have not visited an emergency department in the past 12 months and 6107 participants (27.5%) who have visited an emergency department in the past 12 months. Multivariable logistic regression analysis suggested the following factors are associated with emergency department visits; younger age (odds ratio [OR] with increasing age: 0.98; 95% CI: 0.98-0.99), female gender (OR: 1.07; 95% CI: 1.00-1.15), African American race (OR: 1.26; 95% CI: 1.13-1.40), unmarried status (OR for married vs unmarried: 0.79; 95% CI: 0.74-0.84), lower yearly earnings (OR: 1.36; 95% CI: 1.20-1.54), poor health status (OR: 7.02; 95% CI: 6.02-8.18) and incomplete health insurance coverage (OR for complete coverage vs incomplete coverage: 0.66; 95% CI: 0.54-0.80). On the other hand, the following factors were associated with subsequent hospitalization: older age (OR: 1.004; 95% CI: 1.000-1.008), male gender (OR for female vs male: 0.86; 95% CI: 0.78-0.94), unmarried status (OR for married vs unmarried status: 0.80; 95% CI: 0.73-0.88), not working (OR: 1.44; 95% CI: 1.23-1.68), lower yearly earnings (OR: 1.31; 95% CI: 1.07-1.60), poor health status (OR: 8.43; 95% CI: 6.76-10.51) and lack of health insurance coverage (OR for complete coverage vs incomplete coverage: 0.71; 95% CI: 0.55-0.93). Conclusion: Female cancer survivors were more likely to visit the emergency department, whereas they were less likely to be subsequently hospitalized. Cancer survivors with lower socioeconomic status were more likely to visit emergency departments and to be subsequently hospitalized.
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Affiliation(s)
- Omar Abdel-Rahman
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, T6G 1Z2, Canada
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Mills SEE, Geneen LJ, Buchanan D, Guthrie B, Smith BH. Factors associated with unscheduled care use by cancer decedents: a systematic review with narrative synthesis. BMJ Support Palliat Care 2020:bmjspcare-2020-002410. [PMID: 33051311 DOI: 10.1136/bmjspcare-2020-002410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/09/2020] [Accepted: 09/20/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND People who die from cancer (cancer decedents) may experience unpleasant and distressing symptoms which cause them to present to unscheduled care. Unscheduled care is unplanned care delivered by general practitioner out-of-hours and emergency departments. Use of unscheduled care can disrupt treatment plans, leading to a disjointed patient care and suboptimal outcomes. OBJECTIVES This systematic review aimed to identify factors associated with unscheduled care use by cancer decedents. METHOD Systematic review with narrative synthesis of seven electronic databases (PubMed; Medline; Embase; Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials; Web of Science; Cumulative Index to Nursing and Allied Health Literature) from inception until 01 January 2020. All observational and experimental studies were included, irrespective of their research design. RESULTS The search yielded 238 publications included at full-text, of which 47 were included in the final review and synthesis. Unscheduled care use by cancer decedents was influenced by multiple factors, synthesised into themes: demography, clinical and patient, temporal, prescribing and systems. Cancer decedents who were older, men, had comorbidities, or lung cancer, were most likely to use unscheduled care. Unscheduled care presentations were commonly due to pain, breathlessness and gastrointestinal symptoms. Low continuity of care, and oncology-led care were associated with greater unscheduled care use. Access to palliative care, having an up-to-date palliative care plan, and carer education were associated with less unscheduled care use. CONCLUSION The review identifies multiple factors associated with unscheduled care use by cancer decedents. Understanding these factors can inform future practice and policy developments, in order to appropriately target future interventions, optimise service delivery and improve the patient journey. PROSPERO REGISTRATION NUMBER CRD42016047231.
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Affiliation(s)
- Sarah E E Mills
- Division of Population Health and Genomics, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Louise J Geneen
- Systematic Review Initiative, NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK
| | - Deans Buchanan
- Palliative Medicine & Supportive Care, NHS Tayside, Dundee, UK
| | - Bruce Guthrie
- College of Medicine and Veterinary Medicine, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Blair H Smith
- Division of Population Health and Genomics, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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Lin YC, Hsu HK, Lai TS, Chiang WC, Lin SL, Chen YM, Chen CC, Chu TS. Emergency department utilization and resuscitation rate among patients receiving maintenance hemodialysis. J Formos Med Assoc 2019; 118:1652-1660. [PMID: 30711255 DOI: 10.1016/j.jfma.2019.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/03/2019] [Accepted: 01/09/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND End-stage renal disease (ESRD) is a growing global health concern with increased disease burden and high medical costs. Utilization of the emergency department (ED) among dialyzed patients and the associated risk factors remain unknown. METHODS Participants of this study, selected from the National Health Insurance Database in Taiwan, were aged 19-90 years and received maintenance hemodialysis from January 1, 2010, to December 31, 2010. A control group consisting of individuals who did not receive dialysis, selected from the same data source, were matched for age, sex, and the Charlson Comorbidity Index (CCI). Subgroup analysis with hemodialysis frequency was also performed. ED utilization among enrolled individuals was assessed in 2012. Generalized estimating equations with multiple variable adjustments were used to identify risk factors associated with resuscitation during ED visits. RESULTS One group of 2985 individuals who received maintenance hemodialysis, and another group of 2985 patients that did not receive hemodialysis, between January 1, 2010, and December 31, 2010, were included in this study. There were 4822 ED visits in the hemodialysis group, and 1755 ED visits in the non-dialysis group between January 1, 2012, and December 31, 2012. Analysis of multivariable generalized estimating equations identified the risk associated with resuscitation during ED visits to be greater in individuals who were receiving maintenance hemodialysis, aged older than 55 years, hospitalized in the past year, and assigned first and second degree of triage. CONCLUSION Patients receiving maintenance hemodialysis had higher ED utilization and a significantly higher risk of resuscitation during ED visits than those without hemodialysis.
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Affiliation(s)
- Yi-Chih Lin
- Department of Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei City, Taiwan
| | - Hua-Kuei Hsu
- Department of Health Care Management, National Taipei University of Nursing and Health Science, Taipei, Taiwan
| | - Tai-Shuan Lai
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Wen-Chih Chiang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shuei-Liong Lin
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yung-Ming Chen
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Science, Taipei, Taiwan.
| | - Tzong-Shinn Chu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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