Almaawiy Ummukulthum, Pond Gregory R, Sussman Jonathan, Brazil Kevin, Seow Hsien
1McMaster University, Hamilton, ON, Canada.
Palliat Med. 2014 Feb;28(2):176-83. doi: 10.1177/0269216313493125. Epub 2013 Jun 18.
Previous end-of-life cancer research has shown an association between increased family physician continuity of care and reduced use of acute care services; however, it did not focus on a homecare population or control for homecare nursing.
Among end-of-life homecare cancer patients, to investigate the association of family physician continuity with location of death and hospital and emergency department visits in the last 2 weeks of life while controlling for nursing hours.
Retrospective population-based cohort study.
SETTING/PARTICIPANTS: Cancer patients with ≥ 1 family physician visit in 2006 from Ontario, Canada. Family physician continuity of care was assessed using two measures: Modified Usual Provider of Care score and visits/week. Its association with location of death and hospital and emergency department visits in the last 2 weeks of life was examined using logistic regression.
Of 9467 patients identified, the Modified Usual Provider of Care score demonstrated a dose-response relationship with increasing continuity associated with decreased odds of hospital death and visiting the hospital and emergency department in the last 2 weeks of life. More family physician visits/week were associated with lower odds of an emergency department visit in the last 2 weeks of life and hospital death, except for patients with greater than 4 visits/week, where they had increased odds of hospitalizations and hospital deaths.
These results demonstrate an association between increased family physician continuity of care and decreased odds of several acute care outcomes in late life, controlling for homecare nursing and other covariates.
先前的临终癌症研究表明，家庭医生连续性医疗服务的增加与急性护理服务使用的减少之间存在关联；然而，该研究并未聚焦于居家护理人群，也未对居家护理进行控制。
在临终居家护理癌症患者中，研究家庭医生连续性与死亡地点以及生命最后2周内医院和急诊科就诊情况之间的关联，同时控制护理时长。
基于人群的回顾性队列研究。
地点/参与者：2006年在加拿大安大略省有≥1次家庭医生就诊的癌症患者。使用两种方法评估家庭医生的连续性医疗服务：改良的常规医疗服务提供者评分和每周就诊次数。使用逻辑回归分析其与死亡地点以及生命最后2周内医院和急诊科就诊情况之间的关联。
在确定的9467名患者中，改良的常规医疗服务提供者评分显示出剂量反应关系，连续性增加与医院死亡几率降低以及生命最后2周内去医院和急诊科就诊的几率降低相关。每周家庭医生就诊次数越多，与生命最后2周内急诊科就诊几率和医院死亡几率越低相关，但每周就诊次数超过4次的患者除外，这类患者住院和医院死亡的几率增加。
这些结果表明，在控制居家护理和其他协变量的情况下，家庭医生连续性医疗服务的增加与晚年几种急性护理结局几率的降低之间存在关联。
