初级保健环境中 PaTz 与改善姑息治疗之间的关联：一项横断面调查。
The association between PaTz and improved palliative care in the primary care setting: a cross-sectional survey.
机构信息
Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081BT, Amsterdam, The Netherlands.
出版信息
BMC Fam Pract. 2019 Aug 3;20(1):112. doi: 10.1186/s12875-019-1002-z.
BACKGROUND
The PaTz-method (acronym for Palliatieve Thuiszorg, palliative care at home) is perceived to improve coordination, continuity and communication in palliative care in the Netherlands. Although important for further implementation, research showing a clear effect of PaTz on patient-related outcomes is scarce. This study aimed to examine perceived barriers and added value of PaTz and its association with improved care outcomes.
METHODS
Ninety-eight Dutch general practitioners and 229 Dutch district nurses filled out an online questionnaire with structured questions on added value and barrier perception of PaTz-participation, and palliative care provided to their most recently deceased patient, distributed online by Dutch medical and nurses' associations. Data from PaTz-participants and non-participants was compared using Chi-square tests, independent t-tests and logistic regression analyses.
RESULTS
While both PaTz-participants and non-participants perceived PaTz to be beneficial for knowledge collaboration, coordination and continuity of care, time (or lack thereof) is considered the most important barrier for participation. PaTz-participation is associated with discussing five or more end-of-life topics with patients (OR = 3.16) and with another healthcare provider (OR = 2.55). PaTz-participation is also associated with discussing palliative sedation (OR = 3.85) and euthanasia (OR = 2.97) with another healthcare provider. Significant associations with other care outcomes were not found.
CONCLUSIONS
General practitioners and district nurses feel that participating in a PaTz-group has benefits, but perceive various barriers for participation. While participating in a PaTz-group is associated with improved communication between healthcare providers and with patients, the effect on patient outcomes remains unclear. To stimulate further implementation, future research should focus on the effect of PaTz on tangible care characteristics and how to facilitate participation and remove barriers.
背景
PaTz 方法（姑息治疗居家护理的缩写）被认为可以改善荷兰姑息治疗中的协调、连续性和沟通。尽管对于进一步实施很重要，但很少有研究显示 PaTz 对患者相关结果有明显影响。本研究旨在检查 PaTz 的感知障碍和附加值及其与改善护理结果的关系。
方法
98 名荷兰全科医生和 229 名荷兰地区护士通过荷兰医学和护士协会在线分发的在线问卷，用结构化问题回答 PaTz 参与的附加价值和障碍感知，以及对他们最近去世的患者提供的姑息护理。使用卡方检验、独立 t 检验和逻辑回归分析比较 PaTz 参与者和非参与者的数据。
结果
虽然 PaTz 参与者和非参与者都认为 PaTz 有利于知识协作、护理协调和连续性，但时间（或缺乏时间）被认为是参与的最重要障碍。PaTz 参与与与患者讨论五个或更多临终话题（OR=3.16）和与另一名医疗保健提供者讨论（OR=2.55）有关。PaTz 参与也与与另一名医疗保健提供者讨论姑息镇静（OR=3.85）和安乐死（OR=2.97）有关。未发现与其他护理结果有显著关联。
结论
全科医生和地区护士认为参与 PaTz 小组有好处，但认为参与存在各种障碍。虽然参与 PaTz 小组与医疗保健提供者之间的沟通改善有关，并且与患者有关，但对患者结果的影响尚不清楚。为了促进进一步实施，未来的研究应侧重于 PaTz 对有形护理特征的影响以及如何促进参与和消除障碍。
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