NICE guidance that GPs identify patients in cold homes is 'unrealistic', study finds

NICE guidance that says GPs should use medical records to identify patients who are most vulnerable to cold weather is 'unrealistic', researchers have found.

NICE’s guidance on excess winter deaths and illness recommends that GPs use existing data to identify patients most at risk from living in a cold home. However, the study published in the BJGP found that there was little evidence to show that vulnerable people could be identified using routine primary care data.

The researchers from the University of Bristol, UCL and the University of Birmingham analysed data from over 300 practices in the UK for patients aged 65 and over who died over a two-year period. They found that every 1°C drop in temperature was associated with 1.1% increase in deaths, but they could not clearly establish any single group of patients that were particularly affected, despite analysing 34,752 records.

Every year in England and Wales an average of 24,000 extra deaths occur between December and March than in any other four-month period. NICE's guidance recommends that primary care practitioners should 'use existing data, professional contacts and knowledge to identify people who live in cold or hard-to-heat homes'.

However, lead researcher Professor Richard Morris from the University of Bristol said: 'Primary care data does not routinely include information about whether patients’ homes are cold, so there is no simple way for GPs to identify patients most at risk.

'Primary health care professionals, especially GPs, may also have little opportunity to visit people’s homes, which means that they are reliant on the patient disclosing a cold home problem or on other professionals sharing that information. NICE’s recommendation therefore appears unrealistic.'

Alternative methods needed

The study compared the temerature in the local area on dates when a person died with temperatures a month earlier and a month later. Temperatures were generally lower when someone died, but the researchers looked to see if the difference was more marked for some groups than others.

The researchers looked at a range of factors available in electronic patient records, including age, sex, living situation (whether in the community or an institution), location and chronic conditions. They also looked at other factors including deprivation, region, whether the patient had been admitted to hospital as an emergency within the two years before death and the average house energy efficiency for where they lived. No significant associations were found.

Dr Peter Tammes, who analysed the data, said: 'Our study provides no evidence that GPs can easily identify those at risk during cold periods from data available in existing electronic records. Alternative methods are needed if GPs are to implement the NICE recommendation.'

Professor Morris added: 'Given that excess winter mortality persists, it may be more helpful for policy makers and practitioners to focus on improving information sharing between health, social care and the third sector as a way of identifying vulnerable individuals who have poorly heated homes, and on improving the quality of housing, particularly in the private rented sector, where heating and insulation are often poor.'

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