More anticipatory care advocated for older patients with co-morbidity

ACPs allow discussion between patients, professional carers and sometimes family and friends, to ensure patients’ wishes regarding their final stages of care are widely known.  An advanced directive, or living will can then be drawn up, setting out patients’ wishes in the event of a sudden deterioration in health, which may include decisions such as ‘do not resuscitate’.

The authors of the study, have found that more use of ACPs in primary care helped reduce unplanned hospitalisation by 52 per cent as 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 decedents with an ACP, saving those patients from medical procedures they may not have wished to endure.

Dr Adrian Baker, a GP in Nairn, Scotland, who led the study, 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.”

Editor of the BJGP, Professor Roger Jones, added: “As the population ages and multimorbidity becomes an increasing problem, planned management, including the management of terminal illness, is increasingly required. This study helps to emphasise the importance and benefits of this approach, and identifies some of the key ingredients of integrated, anticipatory planning in primary care.”

Also in this issue of the BJGP:

  • Dementia care still needs to be improved. In  an analysis of the annual dementia review in over 50 general practice in  greater Manchester, Amanda Connolly and colleagues found that in over one  third of cases there had been no discussion with carers and in half no review  of social care. There was also evidence of inappropriate prescribing and  monitoring of anti-psychotic medication. Standards of care were higher in  larger general practices.
  • Air travel can be hazardous for  patients with COPD (Chronic Obstrucive Pulmonary Disease). Commenting on a  case study of a female smoker with COPD who became severely breathless on a  flight from Athens to Amsterdam, Ionna Tsiligianni and colleagues point out  that of the 2 billion air travellers each year as many as one in five adults  may have COPD, and may well experience problems requiring in-flight oxygen  administration. The European Lung Foundation has created a database of  information on oxygen policies for over 300 airlines  (




Further information

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Notes to editors

Anticipatory care planning and integration: a primary care pilot study aimed at reducing unplanned hospitalisation. Br J Gen Pract 2012; DOI 10.3399/bjgp12X625175. Baker A, Leak P, Ritchie LD, Lee AJ, Fielding S.


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