Kimura Takuma, Imanaga Teruhiko, Matsuzaki Makoto, Akahoshi Tohru
Department of General Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa; Department of General Medicine, National Hospital Organization, Higashisaitama Hospital, Hasuda, Saitama.
Geriatr Gerontol Int. 2015 Apr;15(4):465-71. doi: 10.1111/ggi.12297. Epub 2014 Apr 28.
To investigate the factors related to communications in home medical care settings, and the association between such factors and a patient's place of death.
A questionnaire survey of 295 families of patients who had previously received home medical care was carried out in June and July 2011. The response rate was 83.8% (n = 227). Following the exclusion of families where the patient was still alive, or where the place of death was unknown, 143 questionnaires were available for analysis. Logistic regression was used to identify significant associations between possible factors related to communication and occurrence of home death.
Home death was observed in 66.4% (n = 95) of the families analyzed. Home death was significantly associated with the frequency of doctor home-visits per week (OR 2.835, 95% CI 1.436-5.597, P = 0.003). There was no statistically significant association between home death and any of the other variables included: malignant tumors as primary disease, independence in daily activity, duration of home medical care, duration of doctor's visits, experience of doctor-patient communication without family, doctor-family communication without the patient or explanation from the doctor on the phone, existence of home-visit nursing services, existence of family's anxieties and/or questions, age of primary caregiver(s) and sex of primary caregiver(s).
The frequency of doctor home-visits was the only factor identified that was positively associated with the occurrence of home death in home medical care settings.
调查家庭医疗护理环境中与沟通相关的因素,以及这些因素与患者死亡地点之间的关联。
2011年6月和7月,对295名曾接受家庭医疗护理的患者家庭进行了问卷调查。回复率为83.8%(n = 227)。在排除患者仍在世或死亡地点不明的家庭后,有143份问卷可供分析。采用逻辑回归分析来确定与沟通相关的可能因素与家庭死亡发生之间的显著关联。
在分析的家庭中,66.4%(n = 95)观察到家庭死亡。家庭死亡与每周医生家访的频率显著相关(比值比2.835,95%置信区间1.436 - 5.597,P = 0.003)。家庭死亡与其他任何变量之间均无统计学显著关联,这些变量包括:作为主要疾病的恶性肿瘤、日常活动的独立性、家庭医疗护理的持续时间、医生家访的持续时间、无家属在场时的医患沟通经历、无患者在场时的医患沟通经历或医生电话解释、是否存在家访护理服务、家属焦虑和/或疑问的存在、主要照顾者的年龄以及主要照顾者的性别。
医生家访频率是唯一被确定与家庭医疗护理环境中家庭死亡发生呈正相关的因素。