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Developing a local service to improve the provision of palliative care to people who use substances

Published online by Cambridge University Press:  18 June 2021

Vyasa Immadisetty*
Affiliation:
Essex Partnership University NHS Foundation Trust
Natasha Palipane
Affiliation:
London School of Hygiene and Tropical Medicine, Farleigh Hospice
Tracy Reed
Affiliation:
Essex Partnership University NHS Foundation Trust
Srirupa Gupta
Affiliation:
Mid and South Essex NHS Foundation Trust
Beverley Pickett
Affiliation:
East Suffolk and North Essex NHS Foundation Trust
Fiona McDowall
Affiliation:
Essex Partnership University NHS Foundation Trust
Julia Thompson
Affiliation:
East Suffolk and North Essex NHS Foundation Trust
*
*corresponding author.
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Abstract

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Aims

To develop a new service model that engages and improves the provision of palliative care to PWUS.

Background

Although people who use substances (PWUS) continue to die prematurely compared to the general population, they are now more likely to die from chronic diseases rather than from drug-related deaths. Challenges to providing palliative care to PWUS include delayed care-seeking behaviours, complex drug interactions and lack of healthcare provider experience.

Method

An informal factorial analysis elucidated population needs through: a review of local databases to estimate the prevalence of palliative need, a thematic review into the deaths of patients in specialist drug services and, a survey of health practitioners’ knowledge and attitudes. These informed the service development phase which involves three key components: 1. A systems approach to increasing patient identification, incorporating key multi-disciplinary stakeholders across hospital- and community-based care 2. Targeted training of healthcare providers and 3. Medicines management for symptom palliation amidst concurrent substance use (including substitution treatments).

Result

The palliative needs of PWUS are under-identified: the local substance service was not partaking in the palliative referral pathway. Only 7% of a local hospice's annual caseload was recognised as having substance use problems. The care pathway was described as fragmented. Although >80% of surveyed palliative care practitioners had experienced caring for PWUS, confidence and knowledge around managing withdrawal, pain and opioid substitution therapies was poor.

Conclusion

A new pathway is designed to identify PWUS and in their last year of life at key treatment points e.g., accident and emergency, ward-based care. The pathway will then streamline referrals to relevant specialist services depending on complexity of palliative/dependency need. Teaching resources and prescribing guidelines have been developed in collaboration with secondary care pain specialists.

Type
Quality Improvement
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists
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