Shoemaker Laura K, Aktas Aynur, Walsh Declan, Hullihen Barbara, Khan Mohammed I Ahmed, Russell Kraig M, Davis Mellar P, Lagman Ruth, LeGrand Susan
Cleveland Clinic Taussig Cancer Institute, Department of Solid Tumor Oncology, The Harry R Horvitz Center for Palliative Medicine, Cleveland, OH 44195, USA.
Am J Hosp Palliat Care. 2012 Dec;29(8):591-8. doi: 10.1177/1049909111433810. Epub 2012 Feb 23.
This was a prospective descriptive study of hospice physician home visits (HVs) conducted by Hospice and Palliative Medicine Fellows. Our objectives were 1) to improve our knowledge of hospice care at home by describing physician HVs 2) to identify the indications for physician HVs and the problems addressed during the HV. Data was collected on 58 consecutive patients using a standardized form completed before and after the home visit. More than half of the persons were women. Most were Caucasian. Median age was 75 years; 57% had cancer; 77% were do-not-resuscitate. 76% HV occurred in the home. The median visit duration was 60 minutes; median travel distance and time 25 miles and 42 minutes, respectively. A hospice nurse case manager was present in 95%. The most common issues addressed during HVs were: health education, symptom management, and psychosocial support. Medication review was prominent. Physicians identified previously unreported issues. Symptom control was usually pain, although 27 symptoms were identified. Medications were important; all home visits included drug review and two thirds drug change. Physicians had unique responsibilities and identified important issues in the HV. Physicians provided both education and symptom management. Physician HVs are an important intervention. HVs were important in continuity of care, however, time-consuming, and incurred considerable travel, and professional time and costs.
这是一项由临终关怀与姑息医学研究员进行的关于临终关怀医生家访（HV）的前瞻性描述性研究。我们的目标是：1）通过描述医生家访来增进我们对居家临终关怀护理的了解；2）确定医生家访的指征以及家访期间所解决的问题。使用在家访前后填写的标准化表格，对58例连续患者收集了数据。超过半数的患者为女性。大多数是白种人。年龄中位数为75岁；57%患有癌症；77%选择不进行心肺复苏。76%的家访在患者家中进行。家访持续时间中位数为60分钟；出行距离和时间中位数分别为25英里和42分钟。95%的家访有临终关怀护士病例管理员在场。家访期间处理的最常见问题是：健康教育、症状管理和心理社会支持。药物审查很突出。医生识别出了之前未报告的问题。症状控制通常针对疼痛，不过共识别出27种症状。药物很重要；所有家访都包括药物审查，三分之二的家访涉及药物更换。医生在家访中有独特的职责并识别出重要问题。医生既提供教育又进行症状管理。医生家访是一项重要干预措施。家访对护理连续性很重要，然而，耗时且出行、专业时间和成本可观。
