January 2015 HPMJC: Palliative Care and heart failure in primary care

by Katherine Sleeman and Tara Whitburn

On Monday 26th January 2015 from 8-9pm London Time (3-4p New York/ET and Noon-1p California/PT) we will be holding the monthly twitter journal club for hospice and palliative medicine: #hpmjc. The aim of the journal club is to provide an informal multidisciplinary forum for discussion of latest research findings, and we hope you will join us!

You can find some more information about the journal club #hpmjc here in a previous Pallimed post.

The paper for discussion this month is ‘Palliative Care among Heart Failure Patients in Primary Care: A Comparison to Cancer Patients Using English Family Practice Data’. The paper was recently published in PLOS ONE, and is open access. Download it free here. We are pleased to announce that lead author of the paper, Dr Amy Gadoud (@agadoud), is joining us during the online discussion. This month’s paper has been chosen by Dr Tara Whitburn (@Tara_esw), a clinical fellow in palliative medicine at the Cicely Saunders Institute, King’s College London. Tara discusses why she has chosen this paper below:

Why this paper?

Over the past decade there has been increasing emphasis on providing care for people with non- malignant conditions such as heart failure. This paper uses data from the Clinical Practice Research Datalink (CPRD) to investigate recognition of the need for palliative care in a traditionally underserved group.

The authors use a national primary care database to investigate inequities with regard to recognition of the need for a palliative approach in heart failure in the primary care setting. They aim to explore whether people with chronic heart failure are identified as needing a palliative care approach, and to investigate the timing of this recognition in terms of the patient’s proximity to death.

How was the data gathered?

The CPRD is a longitudinal de-identified database of primary care medical records, including information gathered from 8% of all primary care practices in England. Data is collected on numerous clinical variables, and includes measures relating to the Quality Outcomes Framework (QOF).

What is Quality Outcomes Framework (QOF)?

The QOF is a voluntary annual reward and incentive programme for General Practitioner (GP) practices in the UK, started in 2004 as part of the new GP contract. Practices receive points for reaching targets and compiling registers of their patients with particular needs or conditions, for example the palliative care register and the heart failure register. The BMA provides a useful guidance document if you are keen to know more on the indicators used in QOF.

What did they find?

The authors found that only 7% of patients with heart failure were entered onto a palliative care register, compared with 48% of cancer patients. In addition, 29% of heart failure patients who were entered onto the register were entered in their last week of life.

Implications for practice and policy

The findings suggest that there is a large difference in recognition of palliative care need among patients with heart failure, compared with patients with cancer.

Questions for discussion

• Are you surprised by these findings?
• What are the policy implications?
• How might these findings impact on your practice?
• Are there any implications outside the English primary care system?
• What are the main strengths and limitations of this study?
• Should all heart failure patients receive palliative care?
• What would you do next?

We look forward to discussing this on 26th January, and hope that you can join us. Just follow
@hpmjc and use #hpmjc.

Regular journal club participant @Elissa_Campbell has written this post on participating in a #hpmjc chat on Twitter.