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Hospital admissions from nursing homes: a qualitative study of GP decision making

Hospital admissions from nursing homes: a qualitative study of GP decision making
Hospital admissions from nursing homes: a qualitative study of GP decision making
BACKGROUND: Decisions regarding the hospitalisation of nursing home residents may present a difficult dilemma for GPs. There are pressures to admit very frail patients with exacerbations of illness even though such frailty may limit the possible health gains. As 'gatekeepers' to NHS, GPs are expected to make best use of resources and may be criticised for 'inappropriate' admissions. Little is understood about the influences on GPs as they make such decisions Aim: To explore GPs views on factors influencing decisions on admitting frail nursing home residents to hospital.

DESIGN AND SETTING: A purposive sample of 21 GPs from two counties in the South of England.

METHOD: Data from semi-structured, one-to-one interviews with GPs were analysed using thematic analysis following principles of the constant comparative method.

RESULTS: This study suggests that while clinical assessment, perceived benefits and risks of admission, and patients' and relatives' preferences are key factors in determining admissions, other important factors influencing decision making include medico-legal concerns, communications, capability of nursing homes and GP workload. These factors were also perceived by GPs as influencing the feasibility of keeping patients in the nursing home when this was clinically appropriate. Key areas suggested by GPs to improve practice were improving communication (particularly informational continuity), training and support for nursing staff, and peer support for GPs. Local initiatives to address these issues were very variable.

CONCLUSION: Developing a systematic palliative care approach to address poor documentation and communication, the capability of nursing homes, and medico-legal concerns has the potential to improve decision-making regarding hospital admissions.
decision making, general practice, geriatrics, nursing homes, palliative care
0960-1643
e538-e545
McDermott, Clare
731edcc4-daf0-432d-98aa-45052beae320
Coppin, Richard
2a2636a3-05e2-4852-89a1-3bedf7e7a176
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Leydon, Geraldine
c5cdaff5-0fa1-4d38-b575-b97c2892ec40
McDermott, Clare
731edcc4-daf0-432d-98aa-45052beae320
Coppin, Richard
2a2636a3-05e2-4852-89a1-3bedf7e7a176
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Leydon, Geraldine
c5cdaff5-0fa1-4d38-b575-b97c2892ec40

McDermott, Clare, Coppin, Richard, Little, Paul and Leydon, Geraldine (2012) Hospital admissions from nursing homes: a qualitative study of GP decision making. British Journal of General Practice, 62 (601), e538-e545. (doi:10.3399/bjgp12X653589). (PMID:22867677)

Record type: Article

Abstract

BACKGROUND: Decisions regarding the hospitalisation of nursing home residents may present a difficult dilemma for GPs. There are pressures to admit very frail patients with exacerbations of illness even though such frailty may limit the possible health gains. As 'gatekeepers' to NHS, GPs are expected to make best use of resources and may be criticised for 'inappropriate' admissions. Little is understood about the influences on GPs as they make such decisions Aim: To explore GPs views on factors influencing decisions on admitting frail nursing home residents to hospital.

DESIGN AND SETTING: A purposive sample of 21 GPs from two counties in the South of England.

METHOD: Data from semi-structured, one-to-one interviews with GPs were analysed using thematic analysis following principles of the constant comparative method.

RESULTS: This study suggests that while clinical assessment, perceived benefits and risks of admission, and patients' and relatives' preferences are key factors in determining admissions, other important factors influencing decision making include medico-legal concerns, communications, capability of nursing homes and GP workload. These factors were also perceived by GPs as influencing the feasibility of keeping patients in the nursing home when this was clinically appropriate. Key areas suggested by GPs to improve practice were improving communication (particularly informational continuity), training and support for nursing staff, and peer support for GPs. Local initiatives to address these issues were very variable.

CONCLUSION: Developing a systematic palliative care approach to address poor documentation and communication, the capability of nursing homes, and medico-legal concerns has the potential to improve decision-making regarding hospital admissions.

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More information

Published date: 1 August 2012
Keywords: decision making, general practice, geriatrics, nursing homes, palliative care
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 206461
URI: http://eprints.soton.ac.uk/id/eprint/206461
ISSN: 0960-1643
PURE UUID: 4d247d3e-1941-4d87-8418-bd92e00c26a0
ORCID for Clare McDermott: ORCID iD orcid.org/0000-0001-7389-2116
ORCID for Geraldine Leydon: ORCID iD orcid.org/0000-0001-5986-3300

Catalogue record

Date deposited: 21 Dec 2011 11:59
Last modified: 26 Nov 2021 02:49

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Contributors

Author: Clare McDermott ORCID iD
Author: Richard Coppin
Author: Paul Little

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