چکیده (انگلیسی):

Background:Approximately 600,000 people die in the UK annually, usually after months or years of
increasing debility. Many patients with advanced conditions are not identified for appropriate support
before they die because they are not seen as having“palliative” care needs. General practice information
technology systems can improve care by identifying patients with deteriorating health so that their
healthcare needs can be reviewed more systematically and effectively. The aim was to develop and test a
computerised search of primary care records in routine clinical practice as a tool to improve patient
identification for a palliative care approach.
Methods:An iterative process of search design and testing followed by implementation and extended
testing of the search output in clinical practice. A three-phase feasibility study: developing a computerised
search, determining its ability to identify patients with deteriorating health from any advanced condition, and
assessing how primary care clinicians use the results to improve patient care. The setting was twelve primary
care teams in two Health Boards in Scotland.
Results:The search identified 0.6–1.7 % of patients in each practice who were not already on the palliative
care register. Primary care clinicians judged that 30–60 % of these patients were at risk of dying or
deterioration over the next 6–12 months. The most common action taken by GPs was to start an electronic
anticipatory care plan.
Conclusions:It is possible to significantly improve the identification of patients for palliative care needs
assessment using a computerised search however barriers remain to GPs’ finding it acceptable. Time-efficient
systemswereimportantaswasagenerictoolforanticipatorycareplanningnotlinkedto ‘palliative’ care.