Prevalence and Characteristics of Patients Being at Risk of Deteriorating and Dying in Primary Care

Abstract

Context: Understanding the prevalence and characteristics of primary care outpatients being at risk of deteriorating and dying may allow general practitioners (GPs) to identify them and initiate end-of-life discussions.

Objectives: This study aimed to investigate the prevalence and characteristics of primary care outpatients being at risk of deteriorating and dying, as determined by the Supportive and Palliative Care Indicators Tool (SPICT™).

Methods: A multicenter cross-sectional observational study was conducted at 17 clinics with 22 GPs. We enrolled all patients aged ≥65 years who visited the GPs in March 2017. We used the Japanese version of the SPICT to identify patients being at risk of deteriorating and dying. We assessed the demographic and clinical characteristics of enrolled patients.

Results: In total, 382 patients with a mean age of 77.4 ± 7.9 years were investigated. Sixty-six patients (17.3%) had ≥2 positive general indicators or ≥1 positive disease-specific indicator in the SPICT-JP. Patients with dementia/frailty, neurological disease, cancer, and kidney disease showed a significantly elevated risk of deteriorating and dying, whereas patients with other specific disease did not. The patients at risk were significantly older and less likely to be living with family at home. They also had a higher Charlson Comorbidity Index score and a lower Palliative Performance Scale score.

Conclusion: Among primary care outpatients aged over 65 years, 17.3% were at risk of deteriorating and dying regardless of their estimated survival time, and many outpatients at risk were not receiving optimal multidisciplinary care.

Keywords: Identification tool; SPICT™; outpatients; primary care.

Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.