Bishop Margaret F, Stephens Lisa, Goodrich Martha, Byock Ira
Department of Palliative Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire 03756-0001, USA.
J Palliat Med. 2009 Jan;12(1):37-44. doi: 10.1089/jpm.2008.0193.
Alleviation of symptoms associated with advanced illness and dying is a fundamental goal and core principle of palliative care. Little research exists regarding hospice programs' practices for prescribing, dispensing, and utilizing medication kits in the home for management of uncontrolled symptoms.
We conducted a telephone survey of all 22 agencies in New Hampshire providing home hospice care. The survey inquired about the timing of medication kit ordering and availability, characteristics of prescribers and pharmacies, kit contents, costs, frequency of use, and perceived impact of kits.
All programs' kits contained medications to treat pain and dyspnea, 81% for nausea and vomiting, and 76% for seizures. Eighty-six percent of agencies (18/21) reported that a medication within the kits was used in more than 50% of cases. Eighty-six percent reported the kits often averted hospital or emergency department visits. Oral, sublingual, and rectal routes of administration were common as was topical preparations of combination medications. Three programs included parenteral morphine in kits. Kits cost less than $50 for the majority of programs.
Hospice programs commonly utilize kits containing prescription medications for the purpose of managing uncontrolled symptoms in the home. There is considerable variation in kit contents and practice. Programs believe that kits diminish emergency department visits and hospitalizations. Research is needed to more fully describe and study the outcomes of these practices.
缓解与晚期疾病及临终相关的症状是姑息治疗的基本目标和核心原则。关于临终关怀项目在家庭中开具、分发和使用药物包以管理未得到控制的症状的做法，相关研究较少。
我们对新罕布什尔州提供家庭临终关怀服务的所有22家机构进行了电话调查。该调查询问了药物包订购和可得性的时间、开处方者和药房的特征、药物包内容、成本、使用频率以及对药物包的感知影响。
所有项目的药物包都含有治疗疼痛和呼吸困难的药物，81%含有治疗恶心和呕吐的药物，76%含有治疗癫痫发作的药物。86%的机构（18/21）报告称，药物包中的一种药物在超过50%的病例中被使用。86%的机构报告称，药物包常常避免了患者前往医院或急诊科就诊。口服、舌下和直肠给药途径很常见，复方药物的局部制剂也是如此。有三个项目在药物包中包含了胃肠外使用的吗啡。大多数项目的药物包成本低于50美元。
临终关怀项目通常使用含有处方药的药物包来管理家庭中未得到控制的症状。药物包的内容和做法存在很大差异。各项目认为药物包减少了急诊科就诊和住院情况。需要开展研究以更全面地描述和研究这些做法的结果。
