Gibbs Louise M E, Khatri Ajeet K, Gibbs J Simon R
St Christopher's Hospice, London, UK.
Palliat Med. 2006 Sep;20(6):603-9. doi: 10.1177/0269216306071063.
To describe English specialist palliative care (SPC) services' provision for, and attitude to, heart failure patients, and to identify developments of particular interest or expertise in this area.
Postal survey of all lead consultants of English SPC services, September 2004.
Of 397 services, 233 replied (response rate 59%); 222 (95%) thought SPC had a role in severe/end stage heart failure, while three (1%) did not. A total of 197 services (85%) accepted heart failure patients, 26 (11%) did not. The most common reasons for not accepting heart failure patients were lack of resources or beds, implications for staff training or an organizational decision. The mean number of heart failure patients currently under a service was 2.2, but 15 had more than five (maximum 53). Fifteen services (6%) had specific referral criteria for heart failure patients, including recurrent hospital admissions without symptomatic improvement, inappropriateness of further hospital admission and severity of heart failure. Twelve services (5%) had or were developing treatment guidelines for heart failure: five were end of life pathways, three covered breathlessness management and three were symptom control guidelines. Some 137 services (59%) described local collaborative initiatives between SPC, heart failure services and primary care, such as mutual education, joint working and working groups. A number of models of joint working practices were described in detail. Twenty-seven (12%) knew of national initiatives.
The current situation of SPC services in England for patients with heart failure varies widely. One in 10 SPC services in this audit did not accept heart failure patients. Few have developed services of significant size. Local collaborative initiatives are common. Specific referral criteria and symptom control guidelines have been developed. Their role in promoting good palliative care in patients with heart failure remains unclear. Better dissemination of practical knowledge gained by these initiatives could significantly improve the provision of SPC services to heart failure patients.
描述英国专科姑息治疗（SPC）服务为心力衰竭患者提供的服务及态度，并确定该领域特别感兴趣或专业的发展情况。
2004年9月对英国所有SPC服务的首席顾问进行邮政调查。
在397项服务中，233项回复（回复率59%）；222项（95%）认为SPC在严重/终末期心力衰竭中发挥作用，而3项（1%）不这样认为。共有197项服务（85%）接收心力衰竭患者，26项（11%）不接收。不接收心力衰竭患者的最常见原因是资源或床位不足、对员工培训的影响或组织决策。目前一项服务下的心力衰竭患者平均数量为2.2名，但有15项服务有超过5名（最多53名）。15项服务（6%）有针对心力衰竭患者的特定转诊标准，包括反复住院但症状无改善、进一步住院不合适以及心力衰竭的严重程度。12项服务（5%）有或正在制定心力衰竭治疗指南：5项是临终路径，3项涵盖呼吸困难管理，3项是症状控制指南。约137项服务（59%）描述了SPC、心力衰竭服务和初级保健之间的地方合作举措，如相互教育、联合工作和工作组。详细描述了一些联合工作实践模式。27项（12%）知晓国家举措。
英国SPC服务针对心力衰竭患者的现状差异很大。此次审计中，十分之一的SPC服务不接收心力衰竭患者。很少有发展到相当规模的服务。地方合作举措很常见。已制定了特定转诊标准和症状控制指南。它们在促进心力衰竭患者的优质姑息治疗中的作用仍不明确。更好地传播这些举措所获得的实践知识可显著改善为心力衰竭患者提供的SPC服务。
