Use of unscheduled care in the last year of life for people with multiple long-term health conditions: a retrospective cohort study of 299 361 decedents.

Abstract

People living with and dying from multiple long-term conditions (MLTCs) are high users of healthcare services. Unscheduled care, the unplanned use of healthcare services, rises dramatically in the last year of life, likely reflecting unmet needs. To characterise Scotland-based decedents with MLTCs in their last year of life and explore the relationship between characteristics and unscheduled care usage over that year. Retrospective cohort study of all individuals who died in Scotland between 1 January 2017 and 31 December 2021. Data were linked across routine NHS Scotland datasets. Associations between sociodemographic factors, MLTCs, and unscheduled care usage in the last year of life were explored through binary logistic regression. In total, 299 361 individuals died in Scotland between 1 January 2017 and 31 December 2021, of whom 136 593 (45.6%) had ≥2 long-term health conditions leading into their last year of life. More decedents with MLTCs (97.1%) used unscheduled care compared with those without (95.6%). When adjusted for sociodemographic factors, those with MLTCs were more likely to use unscheduled care (adjusted odds ratio 1.51, 95% confidence interval = 1.45 to 1.57). People dying with MLTCs had particularly high use of unscheduled care in the last year of life, likely reflecting unmet need. Anticipating and addressing these needs, through usual care providers, could reduce avoidable use of unscheduled care.