Bulkin W, Brown L, Fraioli D, Giannattasio E, McGuire G, Tyler P, Friedland G
Ritter Scheuer Hospice, Beth Abraham Hospital, Bronx, NY 10467.
J Acquir Immune Defic Syndr (1988). 1988;1(4):375-80.
We report on the initial experience in hospice care for a predominantly poor, black and Hispanic intravenous drug user AIDS population in New York City. Hospice care was provided in a skilled nursing facility with a certified hospice program delivering home care and inpatient care. A formal education program preceded patient admission to familiarize the staff and institution with AIDS issues. Between February 1986 and January 1988, 62 of 175 referred patients were accepted for hospice admission. The patients' mean age was 39 years and all had AIDS dementia complex. The mean length of stay was 35 days (range 1-280 days) and a total of 2011 days of hospice care was provided. Ninety-one percent of hospice days were spent on the inpatient unit; only 9% of hospice days were provided at home. Despite the requirement of expensive inpatient hospice care for most patient days, the estimated savings in decreased costs compared to acute hospital inpatient care was $751,488 for these 62 patients. Continuing fear of transmission among hospice staff was not a major problem; however, several unanticipated problems arose including (a) inability to provide home services, (b) continued drug abuse, (c) increased staff stress, (d) difficulty maintaining confidentiality, (e) difficult interactions with funeral directors, and (f) unsupportive and inappropriate funding requirements. Hospice care of AIDS patients is feasible, humane, and cost effective but problems of the intravenous drug using population require special attention and program modifications if hospice care is to be provided for this substantial and growing AIDS population.
我们报告了纽约市一家临终关怀机构为主要是贫穷、黑人及西班牙裔静脉注射吸毒者艾滋病群体提供临终关怀的初步经验。临终关怀服务在一家设有认证临终关怀项目的专业护理机构中提供，该项目提供居家护理和住院护理。在患者入院前开展了一个正规教育项目，以使工作人员和机构熟悉艾滋病问题。1986年2月至1988年1月期间，175名转诊患者中有62名被接受进入临终关怀机构。患者的平均年龄为39岁，均患有艾滋病痴呆综合征。平均住院时间为35天（范围1 - 280天），总共提供了2011天的临终关怀服务。91%的临终关怀天数是在住院部度过的；只有9%的临终关怀天数是在家中提供的。尽管大多数患者天数需要昂贵的住院临终关怀护理，但与急性医院住院护理相比，这62名患者估计节省的费用为751,488美元。临终关怀工作人员中持续存在的对传播的恐惧并非主要问题；然而，出现了几个意外问题，包括（a）无法提供居家服务，（b）持续药物滥用，（c）工作人员压力增加，（d）难以维持保密性，（e）与殡仪馆工作人员的互动困难，以及（f）不支持且不适当的资金要求。为艾滋病患者提供临终关怀是可行、人道且具有成本效益的，但如果要为这一庞大且不断增长的艾滋病群体提供临终关怀，静脉注射吸毒人群的问题需要特别关注并对项目进行调整。
