Rosemann Thomas, Hermann Katja, Miksch Antje, Engeser Peter, Szecsenyi Joachim
Department of General Practice and Health Services Research, University Hospital of Heidelberg, Germany.
BMC Palliat Care. 2007 May 29;6:5. doi: 10.1186/1472-684X-6-5.
The care of palliative patients challenges the health care system in both quantity and quality. Especially the role of primary care givers needs to be strengthened to provide them with the knowledge and the confidence of applying an appropriate end-of-life care to palliative patients. To improve health care services for palliative patients in primary care, interested physicians in and around Heidelberg, Germany, are enabled to participate in the community-based program 'Palliative Medical Initiative North Baden (PAMINO)' to improve their knowledge in dealing with palliative patients. The impact of this program on patients' health and quality of life remains to be evaluated.
METHODS/DESIGN: The evaluation of PAMINO is a non-randomized, controlled study. Out of the group of primary care physicians who took part in the PAMINO program, a sample of 45 physicians and their palliative patients will be compared to a sample of palliative patients of 45 physicians who did not take part in the program. Every four weeks for 6 months or until death, patients, physicians, and the patients' family caregivers in both groups answer questions to therapy strategies, quality of life (QLQ-C15-PAL, POS), pain (VAS), and burden for family caregivers (BSFC). The inclusion of physicians and patients in the study starts in March 2007.
Although participating physicians value the increase in knowledge they receive from PAMINO, the effects on patients remain unclear. If the evaluation reveals a clear benefit for patients' quality of life, a larger-scale implementation of the program is considered.
The study was registered at 'current controlled trials (CCT)', registration number: ISRCTN78021852.
姑息治疗患者的护理在数量和质量上都给医疗保健系统带来了挑战。尤其是初级护理人员的作用需要得到加强，以便为他们提供对姑息治疗患者实施适当临终护理的知识和信心。为了改善初级护理中针对姑息治疗患者的医疗服务，德国海德堡及其周边地区感兴趣的医生能够参与基于社区的“北巴登姑息医学倡议（PAMINO）”项目，以提高他们应对姑息治疗患者的知识。该项目对患者健康和生活质量的影响仍有待评估。
方法/设计：PAMINO的评估是一项非随机对照研究。在参与PAMINO项目的初级护理医生群体中，将45名医生及其姑息治疗患者的样本与45名未参与该项目的医生的姑息治疗患者样本进行比较。在6个月内或直至患者死亡，每四周一次，两组中的患者、医生以及患者的家庭护理人员回答有关治疗策略、生活质量（QLQ-C15-PAL、POS）、疼痛（VAS）以及家庭护理人员负担（BSFC）的问题。医生和患者纳入该研究始于2007年3月。
尽管参与项目的医生重视从PAMINO中获得的知识增长，但对患者的影响仍不明确。如果评估显示对患者生活质量有明显益处，则考虑大规模实施该项目。
该研究在“当前对照试验（CCT）”注册，注册号：ISRCTN78021852。
