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.

Background: People living with and dying from multiple long-term health conditions 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.

Aim: To characterise Scotland-based decedents with multiple long-term health conditions in their last year of life and explore the relationship between characteristics and unscheduled care usage over that year.

Design & setting: Retrospective cohort study of all individuals who died in Scotland between 01/01/2017 and 31/12/2021.

Method: Data were linked across routine NHS Scotland datasets. Associations between sociodemographic factors, multiple long-term health conditions and unscheduled care usage in the last year of life were explored through binary logistic regression.

Results: 299 361 individuals died in Scotland between 01/01/2017 and 31/12/2021 - 136 953 (45.63%) had two or more long-term health conditions leading into their last year of life. More decedents with multiple long-term health conditions (97.1%) used unscheduled care compared to those without (95.6%). When adjusted for sociodemographic factors, those with multiple long-term health conditions were more likely to use unscheduled care (adjusted Odds Ratio 1.51, 95%Confidence Interval 1.45-1.57).

Conclusion: People dying with multiple long-term health conditions have 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.