Feasibility of objectively identifying older patients in the last year of life from routine general practice databases: GP views and possible role for nurses

Description

BackgroundUnobtrusive data extraction of selected items from electronic GP records has facilitated research for over a decade, not only to produce patient profiles but also to generate reminders and evaluate educational interventions.Aim/ObjectivesTo investigate the feasibility of uncovering risk factors for death within a year (near end-of-life indicators) among older patients attending general practice and ascertain GP acceptability of the approach.MethodsRetrospective study mining the MedicineInsight sentinel surveillance database held by NPS MedicineWise using agreed operational definitions of risk factors. The target parameters extracted were based on evidence from the literature, and the target population was the clientele aged 75+ years from (>160,000 patients in >460 practices in all Australian States and Territories). We subsequently conducted in-depth interviews with 15 GPs in QLD and NSW about their acceptability and ease of use in routine practice.FindingsWe found that 19 extractable objective parameters (test results, chronic conditions, health statuses) were statistically significantly associated with death within a year. GPs were hesitant about the use of these without results from validation studies, and found time as the most prominent barrier to managing high-risk patients’ concerns. ImplicationsThis extraction could be automated and turned into prompts for advance care planning discussions. Nurse-led discussions were proposed as a solution, as was negotiation of a new MBS item or add-on reimbursement to the 75+ health assessment. A small pilot is planned in NSW to determine the duration of activities and actual cost of implementing routine screening for near end-of-life indicators followed by advance care planning discussions.

Period	18 Aug 2020
Event title	Australasian Association for Academic Primary Care: 2020 Conference
Event type	Conference
Location	Gold Coast, Australia
Degree of Recognition	International