轻度和重度痴呆老年人的初级姑息治疗质量：使用质量指标进行的国际死亡率随访研究。
Quality of primary palliative care for older people with mild and severe dementia: an international mortality follow-back study using quality indicators.
机构信息
End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
出版信息
Age Ageing. 2018 Nov 1;47(6):824-833. doi: 10.1093/ageing/afy087.
BACKGROUND
measuring the quality of primary palliative care for older people with dementia in different countries is important to identify areas where improvements can be made.
OBJECTIVE
using quality indicators (QIs), we systematically investigated the overall quality of primary palliative care for older people with dementia in three different countries.
DESIGN/SETTING: a mortality follow-back survey through nation- and region-wide representative Sentinel Networks of General Practitioners (GPs) in Belgium, Italy and Spain. GPs registered all patient deaths in their practice. We applied a set of nine QIs developed through literature review and expert consensus.
SUBJECTS
patients aged 65 or older, who died non-suddenly with mild or severe dementia as judged by GPs (n = 874).
RESULTS
findings showed significantly different QI scores between Belgium and Italy for regular pain measurement (mild dementia: BE = 44%, IT = 12%, SP = 50% | severe dementia: BE = 41%, IT = 9%, SP = 47%), acceptance of approaching death (mild: BE = 59%, IT = 48%, SP = 33% | severe: BE = 41%, IT = 21%, SP = 20%), patient-GP communication about illness (mild: BE = 42%, IT = 6%, SP = 20%) and involvement of specialised palliative services (mild: BE = 60%, IT = 20%, SP = 77%). The scores in Belgium differed from Italy and Spain for patient-GP communication about medical treatments (mild: BE = 34%, IT = 12%, SP = 4%) and repeated multidisciplinary consultations (mild: BE = 39%, IT = 5%, SP = 8% | severe: BE = 36%, IT = 10%, SP = 8%). The scores for relative-GP communication, patient death outside hospitals and bereavement counselling did not differ between countries.
CONCLUSION
while the countries studied differed considerably in the overall quality of primary palliative care, they have similarities in room for improvement, in particular, pain measurement and prevention of avoidable hospitalisations.
背景
衡量不同国家老年痴呆症患者初级姑息治疗的质量对于确定可以改进的领域非常重要。
目的
使用质量指标 (QI)，我们系统地调查了三个不同国家老年痴呆症患者初级姑息治疗的整体质量。
设计/设置：通过比利时、意大利和西班牙的全国和地区代表性全科医生（GP）Sentinel 网络进行死亡率随访调查。GP 记录了他们诊所中所有患者的死亡情况。我们应用了一套通过文献回顾和专家共识制定的九个 QI。
受试者
年龄在 65 岁或以上，由 GP 判断为轻度或重度痴呆且非突然死亡的患者（n=874）。
结果
研究结果表明，比利时和意大利的 QI 评分存在显著差异，包括定期疼痛测量（轻度痴呆：BE=44%，IT=12%，SP=50%|重度痴呆：BE=41%，IT=9%，SP=47%）、接受接近死亡（轻度：BE=59%，IT=48%，SP=33%|重度：BE=41%，IT=21%，SP=20%）、患者与 GP 之间关于疾病的沟通（轻度：BE=42%，IT=6%，SP=20%）以及专门姑息治疗服务的参与（轻度：BE=60%，IT=20%，SP=77%）。比利时的评分与意大利和西班牙在患者与 GP 之间关于医疗治疗（轻度：BE=34%，IT=12%，SP=4%）和重复多学科咨询（轻度：BE=39%，IT=5%，SP=8%|重度：BE=36%，IT=10%，SP=8%）的沟通方面存在差异。相对 GP 沟通、患者在医院外死亡和丧亲咨询的评分在国家之间没有差异。
结论
尽管研究的国家在初级姑息治疗的整体质量方面存在很大差异，但在需要改进的方面存在相似之处，特别是在疼痛测量和预防可避免的住院方面。
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