Kuo Lou-Ching, Lee Jung Jae, Cheung Denise Shuk Ting, Chen Ping-Jen, Lin Chia-Chin
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
Department of Nursing, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
BMJ Support Palliat Care. 2019 Sep 17. doi: 10.1136/bmjspcare-2019-001782.
The National Health Insurance programme started providing coverage for inpatient care in palliative care (PC) units of acute care hospitals in 2000; however, initially, only PC provided to patients with terminal cancer was covered. A PC policy that enabled PC reimbursement for patients with dementia was implemented in 2009. However, the association of this PC policy with end-of-life care remains unclear. The study aims to compare the association of the PC policy with end-of-life care between patients with dementia and patients with cancer during the last 6 months of their lives.
We analysed the claims data of 7396 patients dying with dementia (PDD) and 24 319 patients dying with cancer (PDC) during 1997-2013.
Among PDC, while the percentage of receiving PC increased from 3.6% in 1999 to 14.2% by the end of 2000 (adjusted OR (aOR)=4.07, 95% CI 2.70 to 6.13) and from 20.9% in 2010 to 41.0% in 2013 (aOR=1.40, 95% CI 1.33 to 1.47), vasopressor use decreased from 71.6% in 1999 to 35.5% in 2001 (aOR=0.90, 95% CI 0.82 to 0.98). Among PDD, PC use increased from 0.2% in 2009 to 4.9% in 2013 (aOR=2.05, 95% CI 1.60 to 2.63) and cardiopulmonary resuscitation use decreased from 17.6% in 2009 to 10.0% in 2013 (aOR=0.83, 95% CI 0.76 to 0.90).
Implementation of the PC policy in Taiwan was associated with improved PC utilisation among patients with cancer and dementia, which may reduce unnecessary medical care procedures.
国民健康保险计划于2000年开始为急性护理医院姑息治疗（PC）病房的住院护理提供保险；然而，最初，仅涵盖为晚期癌症患者提供的姑息治疗。一项允许为痴呆症患者报销姑息治疗费用的政策于2009年实施。然而，这项姑息治疗政策与临终关怀之间的关联仍不明确。本研究旨在比较痴呆症患者和癌症患者在生命最后6个月期间姑息治疗政策与临终关怀之间的关联。
我们分析了1997 - 2013年间7396例痴呆症临终患者（PDD）和24319例癌症临终患者（PDC）的理赔数据。
在PDC中，接受姑息治疗的比例从1999年的3.6%增至2000年底的14.2%（校正比值比（aOR）=4.07，95%置信区间2.70至6.13），以及从2010年的20.9%增至2013年的41.0%（aOR = 1.40，95%置信区间1.33至1.47），血管加压药的使用从1999年的71.6%降至2001年的35.5%（aOR = 0.90，95%置信区间0.82至0.98）。在PDD中，姑息治疗的使用从2009年的0.2%增至2013年的4.9%（aOR = 2.05，95%置信区间1.60至2.63），心肺复苏的使用从2009年的17.6%降至2013年的10.0%（aOR = 0.83，95%置信区间0.76至0.90）。
台湾地区姑息治疗政策的实施与癌症和痴呆症患者姑息治疗利用率的提高相关，这可能减少不必要的医疗程序。
