Sutradhar Rinku, Barbera Lisa, Seow Hsien-Yeang
1 Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
2 Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Palliat Med. 2017 May;31(5):448-455. doi: 10.1177/0269216316663508. Epub 2016 Aug 9.
Prior work shows that palliative homecare services reduce the subsequent need for hospitalizations and emergency services; however, no study has investigated whether this association is present for emergency department visits of high acuity or whether it only applies to low-acuity emergency department visits.
To examine the association between palliative versus standard homecare nursing and the rate of high-acuity and low-acuity emergency department visits among cancer decedents during their last 6 months of life.
This is a retrospective cohort study of end-of-life homecare patients in Ontario, Canada, who had confirmed cancer cause of death from 2004 to 2009. A multivariable Poisson regression analysis was implemented to examine the association between the receipt of palliative homecare nursing (vs standard homecare nursing) and the rate of high- and low-acuity emergency department visits, separately.
There were 54,743 decedents who received homecare nursing in the last 6 months of life. The receipt of palliative homecare nursing decreased the rate of low-acuity emergency department visits (relative rate = 0.53, 95% confidence interval = 0.50-0.56) and was significantly associated with a larger decrease in the rate of high-acuity emergency department visits (relative rate = 0.37, 95% confidence interval = 0.35-0.38).
Receiving homecare nursing with palliative intent may decrease the need for dying cancer patients to visit the emergency department, for both high and low-acuity visits, compared to receiving general homecare nursing. Policy implications include building support for additional training in palliative care to generalist homecare nurses and increasing access to palliative homecare nursing.
先前的研究表明，姑息性家庭护理服务可减少后续住院和急诊服务的需求；然而，尚无研究调查这种关联是否存在于高急症的急诊科就诊中，或者它是否仅适用于低急症的急诊科就诊。
研究姑息性家庭护理与标准家庭护理相比，与癌症临终患者生命最后6个月内高急症和低急症急诊科就诊率之间的关联。
这是一项对加拿大安大略省临终家庭护理患者的回顾性队列研究，这些患者在2004年至2009年期间确诊死于癌症。采用多变量泊松回归分析，分别研究接受姑息性家庭护理（与标准家庭护理相比）与高急症和低急症急诊科就诊率之间的关联。
有54743名患者在生命的最后6个月接受了家庭护理。接受姑息性家庭护理降低了低急症急诊科就诊率（相对率=0.53，95%置信区间=0.50-0.56），并且与高急症急诊科就诊率的更大幅度下降显著相关（相对率=0.37，95%置信区间=0.35-0.38）。
与接受普通家庭护理相比，接受有姑息意图的家庭护理可能会减少临终癌症患者高急症和低急症就诊时前往急诊科的需求。政策影响包括为全科家庭护理护士提供更多姑息治疗培训的支持，并增加获得姑息性家庭护理的机会。
