title: Use of a structured palliative care summary in patients with established cancer is associated with reduced hospital admissions by out-of-hours general practitioners in Grampian.
abstract: OBJECTIVE
  Palliative care summaries are used by general practices to provide structured anticipatory care information to those providing care during the out-of-hours period. We hypothesised that the availability of a palliative care summary for individuals with established cancer would influence emergency hospital admission during the out-of-hours period.
  
  
  METHODS
  Each consultation with Grampian Medical Emergency Department (GMED) is recorded on the ADASTRA software system and the nature of the consultation is Read coded. We retrospectively reviewed consultations between 1 January 2011 and 31 December 2011 which had been coded as 'neoplasm' or 'terminal care'. The availability of a palliative care summary on ADASTRA and admission status were recorded. χ(2) Test of association was performed. Binary logistic regression was used for multivariate analysis exploring the effect of a palliative care summary on admission, while adjusting for important confounders.
  
  
  RESULTS
  401 patients with established cancer were identified who had presented to GMED in 2011. 35.7% had a palliative care summary available on ADASTRA. Of the 401 contacts, 100 patients were admitted to hospital. Not having a palliative care summary made admission significantly more likely; χ(2)=12.480, p=0.001. (OR 2.425, 95% CI 1.412 to 4.165).
  
  
  CONCLUSIONS
  Availability of a structured palliative care plan can aid decision making in the out-of-hours period and prevent unplanned hospital admissions.
authors.affiliation: Centre for Academic Primary Care, University of Aberdeen, Aberdeen, UK.
authors.forename: Asia Andeleeb
authors.initials: AA
authors.lastname: Ali
authors.forename: Rosalind
authors.initials: R
authors.lastname: Adam
authors.forename: David
authors.initials: D
authors.lastname: Taylor
authors.forename: Peter
authors.initials: P
authors.lastname: Murchie
mesh_terms: D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000458:organization & administration*; D000368:Aged; D002648:Child; D002675:Child, Preschool; D057286:Electronic Health Records; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D058006:General Practice / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000628:therapy*; D010166:Palliative Care / Q000458:organization & administration*; D010343:Patient Admission / Q000706:statistics & numerical data*; D012606:Scotland; D014600:Utilization Review / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Cancer; Home care; Supportive care