Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
Fam Pract. 2020 Jul 23;37(3):340-347. doi: 10.1093/fampra/cmz059.
General practitioners (GPs) may play an important role in providing end-of-life care to community-dwelling people.
To investigate patients' contacts with GPs, GPs' interdisciplinary collaboration, out-of-hours services and hospitalizations in the last 13 weeks of life and associations with dying at home. Second, investigate whether GP contacts were associated with fewer out-of-hours contacts or days hospitalized.
Individually linked data from the Norwegian Cause of Death Registry, Norwegian Patient Registry, Statistics Norway and Control and Payment of Reimbursement to Health Service Providers database for all 80 813 deceased people in Norway within 2012-13. Outcomes were analyzed with logistic regression and negative binomial multilevel mixed-effect models.
Overall, 1% of people received GP home visits in Week 13 and 4.6% in the last week before death. During the last 4 weeks of life, 9.2% received one or more GP home visits. Altogether, 6.6% received one or more home visits when the GP had one or more interdisciplinary collaborations during the last 4 weeks, of which <3% died at home. GP office consultations decreased towards the end of life. The likelihood of home death versus another location increased in relation to GP home visits [one home visit odds ratio (OR) 1.92, confidence interval (CI) 1.71-2.15; two or more OR 3.49, CI 3.08-3.96] and GP interdisciplinary collaboration (one contact OR 1.76, CI 1.59-1.96; two or more OR 2.52, CI 2.32-2.74).
GPs play a role in enabling people to die at home by performing home visits and collaborating with other health care personnel. Only a minority received such services in Norway.
全科医生（GP）在为社区居民提供临终关怀方面可能发挥重要作用。
调查患者与全科医生的接触情况、全科医生的跨学科合作、临终前 13 周的非工作时间服务和住院情况以及与在家中死亡的关系。其次，调查 GP 接触是否与非工作时间接触或住院天数减少有关。
使用挪威死因登记处、挪威患者登记处、挪威统计局和控制与支付卫生服务提供者补偿数据库中 2012-13 年期间所有 80813 名挪威死者的个人链接数据。使用逻辑回归和负二项式多层混合效应模型分析结果。
总体而言，1%的人在第 13 周和死亡前一周的最后一周接受了 GP 上门访问，4.6%。在生命的最后 4 周内，9.2%的人接受了一次或多次 GP 上门访问。在生命的最后 4 周内，全科医生有一次或多次跨学科合作时，总共 6.6%的人接受了一次或多次上门访问，其中<3%的人在家中死亡。GP 门诊就诊次数在生命末期减少。与其他地点相比，在家中死亡的可能性随着 GP 上门访问的增加而增加[一次上门访问的比值比（OR）为 1.92，置信区间（CI）为 1.71-2.15；两次或更多次 OR 为 3.49，CI 为 3.08-3.96]和 GP 跨学科合作（一次接触 OR 为 1.76，CI 为 1.59-1.96；两次或更多次 OR 为 2.52，CI 为 2.32-2.74）。
GP 通过上门访问和与其他医疗保健人员合作，在使人们能够在家中死亡方面发挥作用。在挪威，只有少数人接受此类服务。
