COVID-19 大流行对台湾退伍军人事务管理系统中使用预先护理计划服务的影响。
Impact of the COVID-19 pandemic on the use of advance care planning services within the veterans administration system in Taiwan.
机构信息
Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Department of Family Medicine, Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
出版信息
J Chin Med Assoc. 2021 Feb 1;84(2):197-202. doi: 10.1097/JCMA.0000000000000459.
BACKGROUND
The aim of this study is to investigate the effect of COVID-19 on the outpatient advance care planning (ACP) services provided by veterans hospitals in Taiwan.
METHODS
This study adopted a retrospective data analysis. We investigated ACP services provided by 15 veterans hospitals in Taiwan from 2019 to June 2020. We also conducted a statistical analysis on the ACP services provided by the Taipei Veterans General Hospital.
RESULTS
From 2019 to June 2020, 15 veterans hospitals in Taiwan provided ACP services to 2493 individuals. The outpatient ACP services declined significantly after January 2020, decreasing from a national average of 206.2 ± 29.2 declarants per month to 106.2 ± 30.8 declarants per month in the 6 months immediately following the COVID-19 pandemic outbreak (p < 0.001). From the official implementation of the ACP in January 2019 to the end of June 2020, a total of 1126 declarants accepted ACP services at the Taipei Veterans General Hospital. When the COVID-19 pandemic was prevalent, the declarants who received ACP services were younger (i.e., 60.1 ± 15.2 vs 65.5 ± 16.3 years; p < 0.001). After the variables had been adjusted, the changes in the characteristics of the declarants receiving ACP services when the COVID-19 pandemic was prevalent were as follows: a significant increase in the percentage of hospital staff receiving ACP services (odds ratio [OR]: 5.460, 95% confidence interval [CI]: 2.378-12.536); An increase in the percentage of declarants who paid for the ACP services received at their own expense (OR: 3.417, 95% CI: 1.591-7.339); and an increase in the percentage of declarants who received the consultations with three or more people (OR: 2.017, 95% CI: 1.278-3.182).
CONCLUSION
COVID-19 severely changed outpatient ACP services provided by hospitals. The results obtained by this study offer valuable insight regarding the provision of outpatient ACP services.
背景
本研究旨在探讨 COVID-19 对台湾退伍军人医院提供的门诊预先医疗照护计划 (ACP) 服务的影响。
方法
本研究采用回顾性数据分析。我们调查了台湾 15 家退伍军人医院 2019 年至 2020 年 6 月间提供的 ACP 服务，并对台北荣民总医院提供的 ACP 服务进行了统计分析。
结果
2019 年至 2020 年 6 月，台湾 15 家退伍军人医院共为 2493 人提供了 ACP 服务。2020 年 1 月后，门诊 ACP 服务显著下降，从 COVID-19 疫情爆发前的每月全国平均 206.2±29.2 名宣告者下降至 6 个月后的 106.2±30.8 名宣告者（p<0.001）。从 2019 年 1 月 ACP 正式实施到 2020 年 6 月底，共有 1126 名宣告者在台北荣民总医院接受了 ACP 服务。在 COVID-19 大流行期间，接受 ACP 服务的宣告者年龄更小（即 60.1±15.2 岁 vs. 65.5±16.3 岁；p<0.001）。调整变量后，COVID-19 大流行期间接受 ACP 服务的宣告者特征的变化如下：接受 ACP 服务的医院工作人员比例显著增加（优势比[OR]：5.460，95%置信区间[CI]：2.378-12.536）；自付费接受 ACP 服务的宣告者比例增加（OR：3.417，95% CI：1.591-7.339）；接受三人以上咨询的宣告者比例增加（OR：2.017，95% CI：1.278-3.182）。
结论
COVID-19 严重改变了医院提供的门诊 ACP 服务。本研究的结果为门诊 ACP 服务的提供提供了有价值的见解。
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