@DanLasserson Critical Importance of OOH Primary Care Covers - - PowerPoint PPT Presentation

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danlasserson critical importance of ooh primary care
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@DanLasserson Critical Importance of OOH Primary Care Covers - - PowerPoint PPT Presentation

Feb 12, 2024 353 likes •523 views

Out of Hours Primary Care Use at the End of Life Dan Lasserson MA MD FRCP Edin MRCGP Senior Interface Physician in Acute and Complex Medicine Dept of Geratology, OUH NHS FT Associate Professor, Nuffield Department of Medicine @DanLasserson

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Out of Hours Primary Care Use at the End of Life

Dan Lasserson MA MD FRCP Edin MRCGP Senior Interface Physician in Acute and Complex Medicine Dept of Geratology, OUH NHS FT Associate Professor, Nuffield Department of Medicine @DanLasserson

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  • Covers primary medical care for the whole population for

2/3 of the hours of the week

  • 18:30 – 08:00 weekdays, 24 hour weekends and BHs
  • 2013-14 = 5.8 million cases, 3.3 million face to face

consultations and 800,000 home visits

Critical Importance of OOH Primary Care

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  • Clinical work is complex and risk is greater than in ‘normal general

practice’

  • Patients are unwell enough to seek care from an unfamiliar

doctor in an unfamiliar setting

  • Access to health records can be limited, access to diagnostics

and wider multidisciplinary team limited.

Risk, infrastructure, and research in OOH care

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OOH Clinical Research Team

Gail Hayward NIHR Academic Clinical Lecturer Nuffield Department of Primary Care Health Sciences, University of Oxford Rebecca Fisher National Medical Director’s Fellow Health Foundation Rachel Brettell NIHR Academic Clinical Fellow Nuffield Department of Primary Care Health Sciences, University of Oxford

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Where do we start?

  • Population based OOH

primary care service

  • 600,000 people
  • Urban and rural settings
  • Who does the OOH

service see with palliative care needs?

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Study conducted over 4 years 2010-2014

All contacts

  • 496,431 contacts

Palliative coded contacts

  • 6045 contacts
  • 1.2% of all contacts

Individual patients

  • 3760 patients
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Palliative Care and Age in OOH

Br J Gen Pract 2016; DOI: 10.3399/bjgp16X686137

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When do patients contact the service?

  • 50.2% contact the service during the daytime on

Saturday and Sunday

  • 28.5% of contacts during the evenings
  • 19.3% of contacts overnight
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Is Access Universal?

Br J Gen Pract 2016; DOI: 10.3399/bjgp16X686137

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  • 5% admitted to hospital
  • 35% – no specific further follow up
  • 42% - asked to contact their own GP for further

management of symptoms

Outcomes after OOH assessment

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  • What happens at a ‘palliative’ OOH consultation?
  • How many patients that die in a population access OOH

care beforehand?

  • Do we fail to recognise the palliative phase of illness?

We still don’t know……

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  • OOH is a significant provider of care in the last month
  • f life in a population
  • What is the optimal model of end of life care?
  • universal access
  • appropriate recognition
  • what is needed from the encounter
  • ongoing support and integration across OOH and

In Hours primary care

End of life care and OOH care

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  • Oxford Health NHS Foundation Trust, Urgent and

Ambulatory Care Service

  • Oxfordshire Health Services Research Committee
  • Staff at Sue Ryder, Nettlebed

Acknowledgements

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Out of Hours Primary Care Use at the End of Life

Dan Lasserson MA MD FRCP Edin MRCGP Senior Interface Physician in Acute and Complex Medicine Dept of Geratology, OUH NHS FT Associate Professor, Nuffield Department of Medicine @DanLasserson