Tolson Debbie, Fleming Anne, Hanson Elizabeth, de Abreu Wilson, Crespo Manuel Lillo, Macrae Rhoda, Jackson Graham, Hvalič-Touzery Simona, Holmerová Iva, Routasalo Pirkko
Alzheimer Scotland Centre for Policy and Practice, Hamilton, The University of the West of Scotland, ML3 0JB, UK.
Bishopbriggs, Glasgow, UK.
Int J Integr Care. 2016 Dec 31;16(4):18. doi: 10.5334/ijic.2497.
This paper examines the provision of integrated advanced dementia care within seven European countries and critically reviews the potential contribution of the Prudent Healthcare perspective as a starting point for reform. Progressive efforts to innovate, promote quality and integrate care are tempered with the reality of resource constraints. Some policy makers in Europe and North America have turned their attention to the principles of Prudent Healthcare as a potential mechanism to maximise benefits for patients within available resources. As dementia progresses, living well requires increasing levels of support and care, people living with advanced dementia have complex health and social care needs, are highly dependent on others but are not yet at the terminal end stage of the condition. People with advanced dementia can benefit from a dementia specific palliative approach to care (), that helps them to live the best life possible for the months and often years they live with advanced dementia. It is also highly desirable to align policy innovations with integrated palliative care practice models and the education of the dementia workforce to accelerate informed improvements in advanced dementia care. There may be some coherence, at least superficially between Prudent Healthcare and integrated palliative care models such as . It is argued that for successful implementation, both require practitioners to be equipped with knowledge and skills and be empowered to deliver high quality care often within impoverished care environments. Adoption of the prudent perspective will however require development of a repertoire of approaches to hear the voice or proxy voice of people living with advanced dementia and to commit to the development and implementation of new evidence for advanced dementia practice. Evidence informing this policy debate draws upon contemporary literature and policy and the findings from research activities undertaken by the project supported through the Erasmus+ K2 Strategic Partnerships funding programme.
本文考察了七个欧洲国家综合晚期痴呆症护理的提供情况，并批判性地审视了审慎医疗视角作为改革起点的潜在贡献。在资源限制的现实情况下，创新、提升质量和整合护理的渐进努力受到了制约。欧洲和北美的一些政策制定者已将注意力转向审慎医疗原则，将其作为在现有资源范围内为患者实现利益最大化的潜在机制。随着痴呆症的发展，要过上良好生活需要越来越多的支持和护理，晚期痴呆症患者有复杂的健康和社会护理需求，高度依赖他人，但尚未处于疾病的终末期。晚期痴呆症患者可从针对痴呆症的姑息治疗方法中受益，这种方法能帮助他们在患有晚期痴呆症的数月乃至数年里尽可能过上最好的生活。使政策创新与综合姑息治疗实践模式以及痴呆症护理人员的教育保持一致，以加速晚期痴呆症护理方面明智的改进，这一点也非常可取。审慎医疗与诸如……等综合姑息治疗模式之间可能至少在表面上存在一些一致性。有人认为，要成功实施，两者都要求从业者具备知识和技能，并被赋予在贫困护理环境中提供高质量护理的权力。然而，采用审慎视角将需要开发一系列方法，以倾听晚期痴呆症患者的声音或其代理人的声音，并致力于为晚期痴呆症实践开发和实施新的证据。为这场政策辩论提供信息的证据借鉴了当代文献和政策，以及通过伊拉斯谟+ K2战略伙伴关系资助计划支持的……项目开展的研究活动的结果。
