1 Dipartimento Fragilità, ASST Lecco , Lecco, Italy .
2 Epidemiology and Programming Service, Department of Planning, Purchasing and Control ATS Brianza , Monza, Italy .
J Palliat Med. 2018 May;21(5):631-637. doi: 10.1089/jpm.2017.0404. Epub 2018 Mar 20.
The aim of this study was to illustrate the characteristics of patients with palliative care (PC) needs, early identified by general practitioners (GPs), and to analyze their care process in home PC services.
Early identification and service integration are key components to providing quality palliative care (PC) services ensuring the best possible service for patients and their families. However, in Italy, PC is often provided only in the last phase of life and for oncological patients, with a fragmented service.
Multicenter prospective observational study, lasting in total 18 months, implemented in a sample of Italian Home Palliative Care Units (HPCUs), enrolling and monitoring patients with limited life expectancy, early identified by 94 GPs. The study began on March 1, 2014 and ended on August 31, 2015.
Nine hundred thirty-seven patients, out of a total pool of 139,071, were identified by GPs as having a low life expectancy and PC needs. Of these, 556 (59.3%) were nononcological patients. The GPs sent 433 patients to the HPCUs for multidimensional assessment, and 328 (75.8%) were placed in the care of both settings (basic or specialist). For all patients included in the study, both oncological and nononcological patients, there was a high rate of death at home, around 70%.
This study highlights how a model based on early identification, multidimensional evaluation, and integration of services can promote adequate PC, also for noncancer patients, with a population-based approach.
本研究旨在阐明由全科医生（GP）早期识别的有姑息治疗（PC）需求的患者的特征，并分析其在家庭 PC 服务中的治疗过程。
早期识别和服务整合是提供高质量姑息治疗（PC）服务的关键组成部分，可确保为患者及其家属提供最佳服务。然而，在意大利，PC 通常仅在生命的最后阶段提供，且仅针对肿瘤患者，服务碎片化。
这是一项多中心前瞻性观察研究，总共持续 18 个月，在意大利家庭姑息治疗单位（HPCUs）的样本中实施，纳入并监测由 94 名 GP 早期识别的预期寿命有限、有 PC 需求的患者。研究于 2014 年 3 月 1 日开始，于 2015 年 8 月 31 日结束。
在总共 139071 名患者中，有 937 名 GP 识别为预期寿命较短且有 PC 需求。其中，556 名（59.3%）是非肿瘤患者。GP 将 433 名患者转介至 HPCUs 进行多维评估，其中 328 名（75.8%）在两种环境（基础或专科）中接受治疗。对于所有纳入研究的患者，包括肿瘤患者和非肿瘤患者，在家中死亡的比例都很高，约为 70%。
本研究表明，基于早期识别、多维评估和服务整合的模式可以促进适当的 PC，也可以为非癌症患者提供以人群为基础的方法。
