Anticipatory Care Plans reduce inappropriate hospital admissions

Anticipatory Care Plans reduce inappropriate hospital admissions

A study in this month’s British Journal of General Practice found that more use of anticipatory care plans in primary care helped to reduce unplanned hospitalisations by 52%.

Surveys show that when asked, most people say they would prefer to die at home, yet most people die in hospital. Admitting someone to hospital when they are dying can often cause additional stress and discomfort to individuals and their families at a most distressing time. Not only are such inappropriate unplanned hospital admissions unwanted by individuals and their families, but they are also extremely costly and put stress on NHS systems. Thus, finding ways of enabling people to stay at home in the last days of their life gives individuals and families what they want, while saving the NHS considerable sums of money.

In this study efforts were made to focus the extended primary care team around patients at risk of admission to hospital, aiming to enable people to be cared for at home or in community settings, rather than being admitted to hospital. Identifying patients at high risk of admission to hospital, and providing them with supported choices around their possible future care options allows them to be more involved in making decisions.

Anticipatory care plans (ACP) are documents used to record discussions between patients and those involved in their care, regarding the patient’s future preferences for treatment and care. A person’s ACP includes information about that person’s wishes in the event of an expected deterioration in their health. With the patient’s consent, the plan can then be shared to ensure that their wishes regarding their final stages of care are widely known.

Dr Adrian Baker, a GP from Nairn, and his colleagues found that more use of ACPs in primary care helped reduce unplanned hospitalisations by 52% because more was understood regarding patients’ wishes surrounding medical interventions. ACPs did not affect the number of deaths of patients who took part in the study, compared to the control group, but the number of patients who died in hospital and the hospital bed days used in the last three months of life were significantly lower for those with an ACP, saving those patients from medical procedures they may not have wished to endure.

Dr Baker said: "Today’s NHS is all about patient choice, but few patients seem to understand the choices available to them in their final few months. Anticipatory care plans are a good way of looking at the options available with a view to ensuring that the wishes of loved ones are fully understood by everyone involved in their care so that unplanned hospitalisation can be avoided.

“We are faced with an ageing population, which is estimated to see 22 per cent of the population aged over 65 years by 2035. GPs have knowledge of a patient’s full medical history and often have a relationship based on trust. They are uniquely placed to broach this issue with the patient to help ensure their final wishes are met.”

Baker, A., Leak, P, Ritchie, L.D., Lee, A.J and Fielding, S. (2012) Anticipatory care planning and integration: a primary care pilot study aimed at reducing unplanned hospitalisation British Journal of General Practice, February 2012

At Good Life, Good Death, Good Grief we believe it is never too early to plan ahead, since planning for illness and death when you’re healthy means there is less to think about if you get sick. For more information about planning ahead see: planning for the future.