Care planning webinar aging2
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Aging2.0 webinar with Willow Health, Dr Vinay Gupta and Richard Wong 14 January 2021 regarding NHS primary care and care planning best practice
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Care planning webinar aging2
- 1. Care Planning Dr Vinay Gupta – GP Partner - Willows Health Dr Richard Wong – Consultant Geriatrician, Director of Older Peoples’ Care - Willows Health
- 2. Serious condition Responding well Now critical Worsened Responding Critical but stable Could be released from hospital Remarkable progress Returns home Critical and at times unstable RIP
- 4. Current Problems with ACP / Care Planning in the Frail Older Population Common barriers to good practice in frailty management and end-of-life care Time, somebody else's job, lack of expertise Misperceptions Lay public Hospitals as places of guaranteed safety I haven’t given up yet - this is not for me Health Professionals Care plans will help to keep people out of hospital Underestimate importance of time and communication (lessons from the LCP) It is possible to predict when an individual is near the end of life – linear decline
- 5. 1st National VOICES survey of bereaved people - 2012 • Coordination of care Only 33% rated this highly Feedback Review reveals 89 patients received substandard care …. palliative care (patients) had tests or investigations which, given their prognosis, were not appropriate Health Service Ombudsman - 2011 • Communication • End-of-life care
- 6. EOL Care – A Process Identify patients Assess needs Communicate & Plan Advance Care Plans The LCP episode Coordinate & Provide Across all sectors Done decreasingly well National Strategies Education
- 7. Leicester, Leicestershire and Rutland ‘Deciding Right’ • EHCP (Emergency Healthcare Plan) - 1°/2 ° care • Patient Information • Training Healthcare workforce
- 8. LLR ‘Deciding Right’ • EHCP (Emergency Healthcare Plan) - 1°/2 ° care • EHCP PCP (2% Frail Popn) • What matters to the individual? • Guidance on escalation of care • Patient Information • Training Healthcare workforce
- 9. • integrated model of care across London • electronic record of patient wishes for those at the EOL Other Initiatives
- 10. • Think: Personalised decisions and care Opportunities for whole care overview
- 11. 203 patients (over 6 months) 113 acute hospital attendances in the 3 months pre-intervention (in 48 patients) vs 71 acute hospital attendances in the 3 months post-intervention (in 24 patients) - decrease of 37% Time spent in hospital for these patients pre-intervention vs post- intervention: 9055 hours vs 4583 hours (decrease of 49%)
Notas del editor
- Consequences of lack of identification Poor care Experiences and available services: cancer vs COPD ‘in the last year of life, patients with COPD have worse quality of life, greater limitation of activity, and more anxiety and depression than patients with lung cancer.’ (Murray et al. 2006) Over-intervention High incidence: prolonged/painful deaths, unwanted/futile interventions (SUPPORT study, Knaus et al. 1995) Physicians lacking confidence to prevent this (Garvin and Chapman, 1995) Unaware of patients’ changing priorities (Steinhauser et al. 2000) Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments What are the uncertainties? Prognosis Future events How far we should investigate illnesses (acute & chronic)? Degrees of Intervention The individual’s best interests Whether or not to hospitalise for medical decompensation or adverse events?