Gagnon Bruno, Nadeau Lyne, Scott Susan, Dumont Serge, MacDonald Neil, Aubin Michèle, Mayo Nancy
Department of Family Medicine and Emergency Medicine, Laval University, Québec City, Canada; Cancer Research Center, Laval University, Québec City, Canada; Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Québec, Canada.
Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Québec, Canada.
J Pain Symptom Manage. 2015 Jul;50(1):48-58. doi: 10.1016/j.jpainsymman.2014.12.012. Epub 2015 Feb 2.
In Canada, governments have increased spending on home care to promote better end-of-life care. In the province of Québec, Canada, home palliative care (PC) services (HPCS) are provided by Public Local Community-Based Health Care Service providers (Centres Locaux de Services Communautaires [CLSC]) with universal coverage. Accordingly, there should be no regional variations of these services and their effect on quality of end-of-life PC (QEoLPC) indicators.
To test if all the CLSCs provided the same level of HPCS to cancer patients in the province of Québec, Canada, and the association between level of HPCS and QEoLPC indicators.
Characteristics of 52,316 decedents with cancer were extracted from administrative databases between 2003 and 2006. Two gender-specific "adjusted performance of CLSCs in delivering HPCS" models were created using gender-specific hierarchical regression adjusted for patient and CLSC neighborhood characteristics. Using the same approach, the strength of the association between the adjusted performance of CLSCs in delivering HPCS and the QEoLPC indicators was estimated.
Overall, 27,255 (52.1%) decedents had at least one HPCS. Significant variations in the adjusted performance of CLSC in delivering HPCS were found. Higher performance led to a lower proportion of men having more than one emergency room visit during the last month of life (risk ratio [RR] 0.924; 95% CI 0.867-0.985), and for women, a higher proportion dying at home (RR 2.255; 95% CI 1.703-2.984) and spending less time in hospital (RR 0.765; 95% CI 0.692-0.845).
Provision of HPCS remained limited in Québec, but when present, they were associated with improved QEoLPC indicators.
在加拿大，政府增加了家庭护理方面的支出，以促进更好的临终护理。在加拿大魁北克省，家庭姑息治疗（PC）服务（HPCS）由基于社区的公共地方医疗保健服务提供商（社区服务中心[CLSC]）提供，覆盖全民。因此，这些服务及其对临终PC质量（QEoLPC）指标的影响不应存在地区差异。
检验加拿大魁北克省所有CLSC是否为癌症患者提供相同水平的HPCS，以及HPCS水平与QEoLPC指标之间的关联。
从2003年至2006年的行政数据库中提取了52316名癌症死者的特征。使用针对患者和CLSC社区特征进行调整的性别特异性分层回归，创建了两个性别特异性的“CLSC提供HPCS的调整后表现”模型。采用相同方法，估计了CLSC提供HPCS的调整后表现与QEoLPC指标之间关联的强度。
总体而言，27255名（52.1%）死者至少接受过一次HPCS。发现CLSC在提供HPCS方面的调整后表现存在显著差异。表现越好，男性在生命最后一个月内多次急诊就诊的比例越低（风险比[RR]0.924；95%置信区间0.867 - 0.985），而女性在家中死亡的比例越高（RR 2.255；95%置信区间1.703 - 2.984），且住院时间越短（RR 0.765；95%置信区间0.692 - 0.845）。
魁北克省的HPCS提供仍然有限，但一旦提供，它们与改善的QEoLPC指标相关。
