Contact with out of hours services by palliative care patients in a rural care setting

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Palliative care provision for patients in rural areas has unique challenges for out of hours usage. GPs on this Scottish island cover both in and out of hour services for 6000 patients with no additional palliative out of hours coverage from district nurses or the Macmillan specialist nurse.


The project aimed to assess the out of hours need of palliative care patients on the island by looking at the demographics of patients, the service contacted and the reason for contact from the start of 2015 until 1st August.


Docman was utilised to identify encounters with out of hours services on the island. 16 palliative care patients were identified in the given time period on the island and became the focus of this project.


For the 16 patients on the island, there were 33 presentations to out of hours in total, with the number of presentations per patient ranging from 0 to 6. The majority of contacts were directly to A+E with only 6/33 contacts via NHS24. Most presentations were disease related (e.g. hiccups, chest infection) though 5/33 contacts were for non-emergency reasons (e.g. prescription request, dressings change). None of the presentations were deemed to be as a result of uncontrolled symptoms.


Out of hours contact was not related to symptom burden, as patients appeared to have well-controlled symptoms. The extent to which this is the result of anticipatory care planning requires further investigation.

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