Jakobsson Eva, Bergh Ingrid, Ohlén Joakim, Odén Anders, Gaston-Johansson Fannie
Faculty of Health Caring Sciences, The Sahlgrenska Academy at Göteborg University, Institute of Nursing, Gothenburg, Sweden.
Health Policy. 2007 Aug;82(3):276-87. doi: 10.1016/j.healthpol.2006.10.003. Epub 2006 Nov 13.
End-of-life care poses a growing clinical and policy concern since most people who are dying utilize health-care services during this period of life. Hence, end-of-life care is a common and integral part of the care provided by health-care systems. There is a growing call for the implementation of a palliative approach as an integral part of all end-of-life care. The purpose of this study was thus to provide policy-makers, health-care providers and professional caregivers with increased knowledge about mainstream patterns of health-care utilization during end-of-life. The patterns of use of health-care services in a Swedish population who accessed the health-care system during their last 3 months of life were in this study examined through a retrospective examinations of medical and nursing records (n=229). We found high prevalences of use of both hospital care, primary care and care provided in people's homes and nearly three quarters of the persons included in the study used between two and three health-care services. However, the probability of using different health-care services was found to be strongly depending on demographic, social, functional and disease related characteristics. The study reveals a considerable use of different health-care services during end-of-life. It is hence essential to, on one hand delineate how such health-care services best can support people at the end-of-life, and on the other hand develop policies which facilitate the process of dying, both in hospitals as well as in peoples' homes. Implications for policy are discussed.
临终关怀引发了越来越多的临床和政策关注，因为大多数临终患者在此期间会使用医疗服务。因此，临终关怀是医疗保健系统所提供护理的常见且不可或缺的一部分。越来越多的人呼吁将姑息治疗方法作为所有临终关怀的一个组成部分加以实施。因此，本研究的目的是为政策制定者、医疗保健提供者和专业护理人员提供更多关于临终期间医疗保健利用主流模式的知识。本研究通过对医疗和护理记录（n = 229）进行回顾性检查，调查了瑞典一群在生命最后3个月内使用医疗保健系统的人群的医疗保健服务使用模式。我们发现，医院护理、初级护理以及居家护理的使用率都很高，并且近四分之三的研究对象使用了两到三种医疗保健服务。然而，发现使用不同医疗保健服务的可能性在很大程度上取决于人口统计学、社会、功能和疾病相关特征。该研究揭示了临终期间对不同医疗保健服务的大量使用。因此，一方面必须明确此类医疗保健服务如何才能最好地支持临终患者，另一方面必须制定政策，以促进医院和居家环境中的临终过程。文中讨论了对政策的影响。
