Grande G E, McKerral A, Todd C J
Health Services Research Group, General Practice and Primary Care Research Unit, University of Cambridge, Cambridge.
Palliat Med. 2002 Mar;16(2):115-23. doi: 10.1191/0269216302pm519oa.
Previous research has shown that palliative home care use is influenced by variables such as age, socioeconomic status, presence of an informal carer, diagnosis, and care dependency. However, there is little information on its association with other health service use. This study compared 121 cancer patients referred to Hospital at Home (HAH) for palliative care with a sample of 206 cancer patients not referred who died within the same period. Electronic record linkage of NHS databases enabled investigation of patients' total input of care in their last year of life. Univariate analysis showed that patients referred to HAH were younger, lived in less deprived areas, were less likely to have been diagnosed within a month of death and to have causes other than cancer recorded on their death certificate. They were furthermore more likely to have had specialist oncology input, Macmillan nursing, Marie Curie nursing, acute hospital care, and district nursing before their last month of life. When care was received, patients referred to HAH received more hours of district nursing care. However, patients not referred to HAH began their acute hospital and district nursing input earlier (further from death) than those referred. Multivariate logistic regression analysis showed HAH referral to be negatively associated with breast and genitourinary cancers and number of noncancer causes recorded on the death certificate. Referral was significantly positively associated with specialist oncology input, Marie Curie nursing, and a late start (close to death) of acute hospital and district nursing care. It is hypothesised that referral to palliative home care is more likely among patients who have had prior contact with cancer services or are most clearly identified as cancer patients, and whose illness progression is manifested by a relatively short but intensive period of care prior to death.
先前的研究表明，姑息性家庭护理的使用受到年龄、社会经济地位、非正式护理人员的存在、诊断以及护理依赖等变量的影响。然而，关于其与其他卫生服务使用之间关联的信息却很少。本研究将121名因姑息治疗被转诊至居家医院（HAH）的癌症患者与206名同期未被转诊且已死亡的癌症患者样本进行了比较。通过英国国家医疗服务体系（NHS）数据库的电子记录链接，能够调查患者在生命最后一年的护理总投入情况。单因素分析显示，被转诊至HAH的患者更年轻，居住在贫困程度较低的地区，在死亡前一个月内被诊断出的可能性较小，且死亡证明上记录的死因除癌症外的其他原因的可能性也较小。此外，他们在生命的最后一个月之前更有可能接受过肿瘤专科投入、麦克米伦护理、玛丽·居里护理、急性医院护理和社区护理。在接受护理时，被转诊至HAH的患者接受的社区护理时长更多。然而，未被转诊至HAH的患者比被转诊患者更早（离死亡时间更远）开始接受急性医院和社区护理投入。多因素逻辑回归分析显示，转诊至HAH与乳腺癌和泌尿生殖系统癌症以及死亡证明上记录的非癌症病因数量呈负相关。转诊与肿瘤专科投入、玛丽·居里护理以及急性医院和社区护理的晚期开始（接近死亡）显著正相关。据推测，在那些之前与癌症服务有过接触或最明确被认定为癌症患者，且其疾病进展表现为在死亡前有一段相对较短但密集的护理期的患者中，转诊至姑息性家庭护理的可能性更大。
