Sun Zhuolu, Laporte Audrey, Guerriere Denise N, Coyte Peter C
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Canadian Centre for Health Economics, Toronto, Ontario, Canada.
Health Soc Care Community. 2017 May;25(3):1127-1138. doi: 10.1111/hsc.12413. Epub 2016 Dec 26.
With health system restructuring in Canada and a general preference by care recipients and their families to receive palliative care at home, attention to home-based palliative care continues to increase. A multidisciplinary team of health professionals is the most common delivery model for home-based palliative care in Canada. However, little is known about the changing temporal trends in the propensity and intensity of home-based palliative care. The purpose of this study was to assess the propensity to use home-based palliative care services, and once used, the intensity of that use for three main service categories: physician visits, nurse visits and care by personal support workers (PSWs) over the last decade. Three prospective cohort data sets were used to track changes in service use over the period 2005 to 2015. Service use for each category was assessed using a two-part model, and a Heckit regression was performed to assess the presence of selectivity bias. Service propensity was modelled using multivariate logistic regression analysis and service intensity was modelled using log-transformed ordinary least squares regression analysis. Both the propensity and intensity to use home-based physician visits and PSWs increased over the last decade, while service propensity and the intensity of nurse visits decreased. Meanwhile, there was a general tendency for service propensity and intensity to increase as the end of life approached. These findings demonstrate temporal changes towards increased use of home-based palliative care, and a shift to substitute care away from nursing to less expensive forms of care, specifically PSWs. These findings may provide a general idea of the types of services that are used more intensely and require more resources from multidisciplinary teams, as increased use of home-based palliative care has placed dramatic pressures on the budgets of local home and community care organisations.
随着加拿大医疗体系的重组，以及护理接受者及其家人普遍倾向于在家中接受姑息治疗，对居家姑息治疗的关注持续增加。多学科医疗专业人员团队是加拿大居家姑息治疗最常见的服务提供模式。然而，对于居家姑息治疗的倾向和强度随时间的变化趋势，我们知之甚少。本研究的目的是评估过去十年中使用居家姑息治疗服务的倾向，以及一旦使用，在三个主要服务类别中的使用强度：医生出诊、护士出诊和个人支持工作者（PSW）提供的护理。使用三个前瞻性队列数据集来跟踪2005年至2015年期间服务使用情况的变化。使用两部分模型评估每个类别的服务使用情况，并进行Heckit回归以评估选择性偏差的存在。使用多元逻辑回归分析对服务倾向进行建模，使用对数变换的普通最小二乘回归分析对服务强度进行建模。在过去十年中，居家医生出诊和PSW服务的倾向和强度均有所增加，而护士出诊的服务倾向和强度则有所下降。与此同时，随着生命接近尾声，服务倾向和强度总体上有增加的趋势。这些发现表明了居家姑息治疗使用增加的时间变化，以及护理方式从护士转向成本较低的护理形式（特别是PSW）的转变。这些发现可能为多学科团队中使用更频繁且需要更多资源的服务类型提供一个大致概念，因为居家姑息治疗使用的增加给当地家庭和社区护理组织的预算带来了巨大压力。
