Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, the Netherlands.
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, the Netherlands.
J Am Med Dir Assoc. 2019 Jun;20(6):696-702.e1. doi: 10.1016/j.jamda.2018.08.015. Epub 2018 Oct 23.
To describe the relation between physician visits and physicians' recognition of a resident's terminal phase in long-term care facilities (LTCFs) in Belgium, England, Finland, Italy, the Netherlands, and Poland.
In each country, a cross-sectional study was conducted across representative samples of LTCFs. Participating LTCFs reported all deaths of residents in the previous 3 months, and structured questionnaires were sent to several proxy respondents including the treating physician.
1094 residents in 239 LTCFs, about whom 505 physicians returned the questionnaire.
Number of physician visits, the resident's main treatment goal, whether physicians recognized the resident's terminal phase and expected the resident's death, and resident and physician characteristics.
The number of physician visits to residents varied widely between countries, ranging from a median of 15 visits in the last 3 months of life in Poland to 5 in England, and from 4 visits in the last week of life in the Netherlands to 1 in England. Among all countries, physicians from Poland and Italy were least inclined to recognize that the resident was in the terminal phase (63.0% in Poland compared to 80.3% in the Netherlands), and residents in these countries had palliation as main treatment goal the least (31.8% in Italy compared to 92.6% in the Netherlands). Overall however, there were positive associations between the number of physician visits and the recognition of the resident's terminal phase and between the number of physician visits and the resident having palliation as main treatment goal in the last week of life.
This study suggests that LTCFs should be encouraged to work collaboratively with physicians to involve them as much as possible in caring for their residents. Joint working will facilitate the recognition of a resident's terminal phase and the timely provision of palliative care.
描述比利时、英国、芬兰、意大利、荷兰和波兰的长期护理机构（LTCF）中医生就诊次数与医生识别居民终末期之间的关系。
在每个国家，对具有代表性的 LTCF 样本进行了横断面研究。参与的 LTCF 报告了前 3 个月内所有居民的死亡情况，并向包括主治医生在内的多名代理受访者发送了结构化问卷。
239 家 LTCF 的 1094 位居民，其中 505 位医生回复了问卷。
就诊次数、居民的主要治疗目标、医生是否识别居民的终末期并预计居民的死亡情况，以及居民和医生的特征。
居民在生命的最后 3 个月接受的医生就诊次数在各国之间差异很大，从波兰中位数为 15 次到英国中位数为 5 次，从荷兰最后一周中位数为 4 次到英国中位数为 1 次。在所有国家中，波兰和意大利的医生最不容易识别居民处于终末期（波兰为 63.0%，荷兰为 80.3%），这些国家的居民也最不可能将姑息治疗作为主要治疗目标（意大利为 31.8%，荷兰为 92.6%）。然而，总体而言，医生就诊次数与识别居民终末期以及医生就诊次数与居民在生命最后一周将姑息治疗作为主要治疗目标之间呈正相关。
本研究表明，应鼓励长期护理机构与医生合作，尽可能让他们参与照顾居民。共同工作将有助于识别居民的终末期，并及时提供姑息治疗。
