Discipline, Palliative and Supportive Services, Flinders University, 700 Goodwood Rd, Daw Park, South Australia, 5041, Australia.
BMC Health Serv Res. 2012 Nov 23;12:424. doi: 10.1186/1472-6963-12-424.
A range of health outcomes at a population level are related to differences in levels of social disadvantage. Understanding the impact of any such differences in palliative care is important. The aim of this study was to assess, by level of socio-economic disadvantage, referral patterns to specialist palliative care and proximity to inpatient services.
All inpatient and community palliative care services nationally were geocoded (using postcode) to one nationally standardised measure of socio-economic deprivation - Socio-Economic Index for Areas (SEIFA; 2006 census data). Referral to palliative care services and characteristics of referrals were described through data collected routinely at clinical encounters. Inpatient location was measured from each person's home postcode, and stratified by socio-economic disadvantage.
This study covered July - December 2009 with data from 10,064 patients. People from the highest SEIFA group (least disadvantaged) were significantly less likely to be referred to a specialist palliative care service, likely to be referred closer to death and to have more episodes of inpatient care for longer time. Physical proximity of a person's home to inpatient care showed a gradient with increasing distance by decreasing levels of socio-economic advantage.
These data suggest that a simple relationship of low socioeconomic status and poor access to a referral-based specialty such as palliative care does not exist. Different patterns of referral and hence different patterns of care emerge.
人群的一系列健康结果与社会劣势程度的差异有关。了解姑息治疗方面的此类差异的影响很重要。本研究旨在根据社会经济劣势程度评估向专科姑息治疗的转诊模式和接近住院服务的程度。
所有全国性的住院和社区姑息治疗服务都通过邮政编码（使用邮政编码）进行地理编码，以达到社会经济剥夺的全国统一衡量标准 - 社会经济区域指数（SEIFA；2006 年人口普查数据）。通过在临床接触中常规收集的数据来描述姑息治疗服务的转诊情况和转诊特征。从每个人的家庭邮政编码衡量住院地点，并按社会经济劣势程度分层。
本研究涵盖了 2009 年 7 月至 12 月，涉及 10064 名患者的数据。来自 SEIFA 最高组（最不贫困）的人被转诊到专科姑息治疗服务的可能性显著降低，更有可能在接近死亡时被转诊，并且住院治疗的次数更多，时间更长。一个人家庭与住院治疗的物理接近程度与社会经济优势程度的增加距离呈梯度下降。
这些数据表明，低社会经济地位和难以获得基于转诊的专业服务（如姑息治疗）之间并不存在简单的关系。出现了不同的转诊模式，因此出现了不同的护理模式。
