General practice service use at the end-of-life before and during the COVID-19 pandemic: a population-based cohort study using primary care electronic health records.

Autor:	Chukwusa E; King's College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK emeka.chukwusa@kcl.ac.uk., Barclay S; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK., Gulliford M; Department of Population Health Sciences, King's College London, Faculty of Life Science & Medicine, London, UK., Harding R; King's College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK., Higginson I; King's College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK., Verne J; Public Health England, Bristol, UK.
Jazyk:	angličtina
Zdroj:	BJGP open [BJGP Open] 2024 Apr 25; Vol. 8 (1). Date of Electronic Publication: 2024 Apr 25 (Print Publication: 2024).
DOI:	10.3399/BJGPO.2023.0108
Abstrakt:	Background: Globally, the COVID-19 pandemic has caused unprecedented strain in healthcare systems, but little is known about how it affected patients requiring palliative and end-of-life care from GPs. Aim: To evaluate the impact of the pandemic on primary care service use in the last 3 months of life, including consultations and prescribing, and to identify associated factors. Design and Setting: A retrospective cohort study in UK, using data from the Clinical Practice Research Datalink. Method: The study cohort included those who died between 2019 and 2020. Poisson regression models using generalised estimation equations were used to examine the association between primary care use and patient characteristics. Adjusted rate ratios (aRRs) and 95% confidence intervals (95% CIs) were estimated. Results: A total of 44 534 patients died during the study period. The pandemic period was associated with an 8.9% increase in the rate of consultations from 966.4 to 1052.9 per 1000 person-months, and 14.3% longer telephone consultation duration (from 10.1 to 11.5 minutes), with a switch from face-to-face to telephone or video consultations. The prescription of end-of-life care medications increased by 6.3%, from 1313.7 to 1396.3 per 1000 person-months. The adjusted rate ratios for consultations (aRR = 1.08, 95% CI = 1.06 to 1.10, P <0.001) and prescriptions (aRR 1.05: 95% CI = 1.03 to 1.07, P <0.001) also increased during the pandemic. Conclusion: The pandemic had a major impact on GP service use, leading to longer consultations, shifts from face-to-face to telephone or video consultations, and increased prescriptions. GP workload-related issues must be addressed urgently to ease the pressure on GPs. (Copyright © 2024, The Authors.)
Databáze:	MEDLINE
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