General practice service use at the end-of-life before and during the COVID pandemic: a population-based cohort study using primary care electronic health records.
BACKGROUND: Globally, the COVID pandemic has caused unprecedented strain in healthcare systems, but little is known about how it affected patients needing palliative and end-of-life care from general practitioners (GPs). AIM: To evaluate the impact of the pandemic on primary care service use in the last three months of life, including consultations and prescribing, and to identify associated factors DESIGN & SETTING: A retrospective cohort study in United Kingdom (UK), using data from the Clinical Practice Research Datalink (CPRD). METHOD: The study cohort included those who died between 2019 and 2020. Poisson regression models using generalised estimation equations (GEE) were used to examine the association between primary care use and patient characteristics. Adjusted Rate Ratios (aRRs) and 95% Confidence Intervals (95%CI) were estimated. RESULTS: A total of 44,534 patients died during the study period. The pandemic period was associated with an 8.9% increase in the rate of consultations from 966.4 to 1052.9 per 1,000 person-months and 14.3% longer telephone consultation duration (from 10.1 to 11.5 minutes), with a switch from face-to-face to telephone/video consultations. The prescription of end-of-life care medications increased by 6.3%, from 1313.7-1396.3 per 1,000 person-months. The adjusted rate ratios for consultations (aRRs: 1.08, 95% CI: 1.06-1.10, P<0.001) and prescriptions (aRRs 1.05: 95% CI 1.03-1.07, P<0.001) also increased during the pandemic. CONCLUSION: The pandemic had a major impact on GP service use, leading to longer consultations, shifts from face-to-face to telephone/video consultations, and increased prescriptions. GP workload-related issues must be addressed urgently to ease the pressure on GPs.