Transcript Dr Elizabeth Phull - Grampian Dementia Care

Anticipatory Care Plans in Dementia Survey of use in Elmbank Group Practice
Dr Elizabeth Phull, Elmbank Group Practice
Introduction
Anticipatory care plans were introduced in October 2011 as part of
the enhanced service contract for general practice, with the aim of
reducing emergency admissions and out of hours contacts. The
target group was initially over 75s.
2013
A breakdown of ACPs by place of residence is given in the
table below.
Patients with dementia can be particularly difficult to assess out of
hours, when seen without the benefit of medical records, and in
some situations there may be little history available. For this group,
an anticipatory care plan providing basic medical information and
details of next of kin or carers can be particularly helpful and may
help prevent an emergency admission.
ACP by place of residence
Aim
This survey looked at the use of anticipatory care plans in patients
with a diagnosis of dementia.
50
45
Methods
Records of all patients with a diagnosis of dementia were reviewed.
Time since diagnosis was recorded in years. Place of residence
was noted according to whether the patient lived in their own home,
in a residential home or in a nursing home. If they lived in their own
home, then a review of recent surgery consultations, home visits, or
letters from old age psychiatry were used to determine whether or
not the patient lived alone.
The number of QOF diagnoses on the problem list, and the number
of repeat medications excluding topical preparations, laxatives and
simple analgesics were also recorded as an indicator of
comorbidity.
It was noted whether an anticipatory care plan had been issued
within the last 12 months.
Results
A total of 118 patients were identified from a practice population of
10389. This figure is 86% of the expected number according to
prevalence statistics from Grampian Health Board, adjusted for the
age of the practice population, but not for deprivation.
A total of 24 anticipatory care plans were in place and had been
either initially completed or updated within the last 12 months. One
patient had a palliative care plan in place, but no ACP and was
therefore not counted although information would have been
available to the OOH service.
Overall approximately 20% of patients diagnosed with dementia
had an anticipatory care plan in place. The number of patients who
had an ACP varied according to their accommodation. The greatest
number were in place for care home residents and the lowest for
nursing home residents.
Patients had been diagnosed with dementia for a mean of 4.0
years (range 0 – 19 years). They had a mean number of 2.6 other
QOF diagnoses (range 0 – 8 ) and were on a mean of 5.3 regular
medications ( range 0 – 16 ).
Percentage with ACP
40
35
30
25
20
15
10
5
0
Own home
not alone
Living alone
Nursing home
Care home
Total
Accommodation
Conclusions
Fewer than the expected number of patients have been diagnosed
with dementia.
Those living alone are a vulnerable group who could benefit from
having an anticipatory care plan, and at present only 17.9% do so.
These patients could be the next cohort for anticipatory care
planning.
A third of all dementia patients are living with someone else, and in
many cases that person will have taken on the role of carer.
This study provides a starting point for identifying the carers of
those with dementia. In most cases, those living with a person who
has dementia will be registered with the same practice and we have
the potential to reduce emergency admissions by supporting
carers, recognising and managing causes of stress and using
facilities such as respite care to help carers continue in their role.
Dementia Scholarship Learning Points
•Learning objectives comprehensively covered.
•The scholarship has provided a good understanding of the post
diagnostic support available.
•Personally better equipped to assess capacity and advise on
power of attorney and guardianship.
•Knowledge of third sector services available to dementia patients
and their families.