Many people in Scotland now benefit from anticipatory care before they die: an after death analysis and interviews with general practitioners

Background

Key Information Summaries (KIS) were introduced throughout Scotland in 2013 so that anticipatory care plans written by general practitioners (GPs) could be routinely shared electronically and updated in real time, between GPs and providers of unscheduled and secondary care.

Aims

We aimed to describe the current reach of anticipatory and palliative care, and to explore GPs’ views on using KIS.

Methods

We studied the primary care records of all patients who died in 2014 in 9 diverse Lothian practices. We identified if anticipatory or palliative care had been started, and if so how many weeks before death and which aspects of care had been documented. We interviewed 10 GPs to understand barriers and facilitating factors.

Results

Overall, 60% of patients were identified for a KIS, a median of 18 weeks before death. The numbers identified were highest for patients with cancer, with 75% identified compared with 66% of those dying with dementia/frailty and only 41% dying from organ failure. Patients were more likely to die outside hospital if they had a KIS. GPs identified professional, patient and societal challenges in identifying patients for palliative care, especially those with non-cancer diagnoses.

Conclusions

GPs are identifying patients for anticipatory and palliative care more equitably across the different disease trajectories and earlier in the disease process than they were previously identifying patients specifically for palliative care. However, many patients still lack care planning, particularly those dying with organ failure.

Improving primary palliative care in Scotland: lessons from a mixed methods study

Background

Since 2012, all GP practices across Scotland have been supported to take a systematic approach to end-of-life care, by helping them to identify more patients for palliative care through a Palliative Care Directed Enhanced Service (DES). We aimed to understand the impact of this initiative.

Methods

Routine quantitative data from the 2012/13, and 2013/14 DES were collected from regional health boards, analysed and discussed. Qualitative data were collected from a sample of 2012/13 DES returns and analysed using Thematic Analysis.

Results

Data were received from 512 practices in nine Scottish Health boards for the 2012-13 DES and 638 practices in 11 Health boards for 2013-14. A sample of 90 of the returns for 2012-13 was selected for qualitative analysis.

In 2012-13, 72 % of patients who died of cancer were listed on the palliative care register (PCR) before death while 27 % of patients who died as a result of non-malignant conditions were listed on the PCR. In 2013-14, cancer identification remained the same but identification of people dying with other long-term conditions had improved to 32.5 %.

We identified several key issues needed to improve palliative care in the community. The need for training to identify patients with palliative care needs (particularly non-cancer); communication skills training; improvements in sharing information across the NHS; under-resource of and lack of coordination with district nurses; improvements in information technology; and tools for working with enlarged palliative care registers.

Conclusions

The DES helped more patients with long-term conditions (LTC) receive generalist palliative care. Approaching generalist palliative care as anticipatory care could facilitate communication between GPs and patients/families and remove some barriers to early identification of palliative care needs. Improvement of information technology and use of identification tools like the SPICT™ may improve professionals’ communication with each other and help may make identification and management of patients easier.

Electronic supplementary material

The online version of this article (doi:10.1186/s12875-015-0391-x) contains supplementary material, which is available to authorized users.

A randomised controlled trial comparing the use of manual versus mechanical compression to obtain haemostasis following coronary angiography

Cardiac interventions have become a commonly accepted treatment option for patients with coronary heart disease. Managing the arterial puncture site and femoral sheath removal is an important aspect of cardiac nursing practice for patients who have had cardiac diagnostic and interventional procedures. The purpose of this study was to compare the use of manual compression with a mechanical compression device in achieving haemostasis after femoral sheath removal in coronary angiography patients and to determine the ability of these two techniques to reduce groin complications. A randomised controlled trial comparing two compression protocols (manual and QuicKlamp) was undertaken on a sample of 100 patients scheduled to have coronary angiography. Descriptive statistics were used to analyse and describe the data. Inter-group comparisons were analysed using either Chi-squared analysis for nominal data, or the Mann-Whitney U-test for continuous variables. The results indicated that the QuicKlamp device took longer to effect haemostasis after femoral sheath removal (P=0.000) and subjects took longer to mobilise than after manual compression (P=0.001). More haematomas occurred following manual compression after pressure dressing removal (P=0.027). At 5-day follow-up, more bruising was identified in those subjects in the QuicKlamp compression group (P=0.046), as was swelling in female subjects (P=0.044). More episodes of chest pain at 5-day follow-up were identified in the manual compression group (P=0.014). The findings demonstrate that QuicKlamp mechanical compression is a safe alternative to manual compression for attaining haemostasis after femoral sheath removal.

Learning needs of Taiwanese nurses caring for patients with irritable bowel syndrome

This study, building on work on irritable bowel syndrome conducted by Letson and Dancey (1996), explores Taiwanese nurses' knowledge, perceptions and beliefs about caring for patients with irritable bowel syndrome (IBS). A 46-item questionnaire was completed voluntarily by 120 registered nurses from a large tertiary acute care facility in Taiwan. The study used a descriptive research design and a questionnaire was developed that used a five-point Likert scale (strongly agree = 5, to strongly disagree = 1). The questionnaire consisted of six categories: demographic information; nurses' sources of IBS information; nurses' knowledge about IBS; nurses' perceptions about patients with IBS; nurses' beliefs about IBS; and learning requirements for nurses. Overall, the results indicted that Taiwanese nurses who participated in this study had little specific knowledge of IBS. The researchers developed a booklet containing information on the condition of IBS that may be used by the participants in this study to fill the knowledge gaps about this condition and provide useful information.

Impact of rural living on the experience of chronic illness

This paper concentrates on the specific impact that living in rural Australia has on the experience of chronic illness, and draws on data collected in a larger phenomenological study. Eighteen rural Australians in New South Wales described their experiences and referred particularly to issues that related to their rural context. A secondary analysis of the data revealed three sub-themes related to the concept of rural, choice of doctor, travelling and life style. The shortfalls in service identified by these participants deserves further investigation and could become fertile ground for an expanded nursing service.

The public health problem of acute respiratory illness in childcare

Acute respiratory illness continues to be a significant problem for children attending childcare. The problems for the child are in terms of prevalence, incidence, and quality of life. Additional costs relate to parental absence from work and loss of earnings. This paper reports on the literature, and notes that little research has been undertaken to determine whether there are long-term risks or benefits to experiencing acute respiratory illness in early childhood. Research to date is presented, and the role of public health nurses is discussed in relation to how they might assist in reducing the incidence/prevalence of acute respiratory illness in children attending childcare.

Acute respiratory illness in the first year of primary school related to previous attendance at child care

The aim of this study was to assess the relationship between previous child care outside the home (day care or family care) and acute respiratory illness in the first year at primary school. Participants were 445 Adelaide school children (mean age 5 years 2 months), 73 per cent of those eligible. Information about early childhood, family, child care arrangements and illness history was obtained from a questionnaire completed by parents. A respiratory illness score was calculated from the parental reports of respiratory illness experience in the winter months of the second school term in 1992. Absences from school owing to respiratory illness were counted from school records. Children who had attended child care before commencing school had fewer episodes of acute respiratory illness and had fewer absences from school than children with no child care experience. Children who had attended child care prior to commencing school experienced half as many episodes of asthma as those children who had never attended child care. Children who attend day care before age five tend to experience less acute respiratory illness than their peers on school entry. Possible explanations include selection of illness-prone children into home care, protection against respiratory illness as a result of early exposure, and a shift in the age-related peak of illness.