Western Australian Centre for Rural Health, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.
BMJ Open. 2021 Mar 16;11(3):e042268. doi: 10.1136/bmjopen-2020-042268.
Anticipation and prompt relief of symptoms among patients with a life-limiting illness is a core element of palliative care. Indigenous Australians commonly encounter cultural barriers in healthcare that may impair outcomes. The Palliative Care Outcomes Collaboration collects patient care data for the purposes of continuous quality improvement and benchmarking, with each recorded care episode divided into phases that reflect a patient's condition. We aimed to investigate differences between Indigenous and non-Indigenous patients in the occurrence and duration of 'unstable' phases (which indicate unanticipated deterioration in a patient's condition or circumstances), and determine attainment of the relevant benchmark (resolution of unstable phases in ≤3 days in 90% of cases) for both groups.
Cohort study.
Australia-wide hospital-based and community-based specialist palliative care (1 January 2010 to 30 June 2015).
139 556 (1502 Indigenous and 138 054 non-Indigenous) adult patients.
Indigenous and non-Indigenous patients were compared on (1) the risk of a phase being categorised as unstable, (2) the duration of unstable phases, and (3) the risk of unstable phases being prolonged (>3 days). Crude and adjusted estimates were produced from three-level robust Poisson regression and complementary log-log discrete time survival models.
Unstable phases occurred with similar frequency overall among Indigenous and non-Indigenous patients (adjusted relative risks 1.06; 95% CI 1.00 to 1.11; not significant after correction for multiple comparisons). The duration and risk of prolongation of unstable phases were similar in both patient groups, with no significant differences evident among subgroups. The benchmark was not met for either Indigenous or non-Indigenous patients (unstable phase duration >3 days in 24.3% vs 25.5%; p=0.398).
Despite well-documented shortcomings of healthcare for Indigenous Australians, there is no clear evidence of greater occurrence or prolongation of unanticipated problems among Indigenous patients accessing specialist palliative care services in hospital or the community.
在患有绝症的患者中，预测并及时缓解症状是姑息治疗的核心要素。澳大利亚原住民在医疗保健中经常遇到文化障碍，这可能会影响治疗效果。姑息治疗结果协作组织收集患者护理数据，目的是进行持续质量改进和基准测试，每个记录的护理事件分为反映患者病情的阶段。我们旨在调查原住民和非原住民患者在“不稳定”阶段（表示患者病情或情况意外恶化）的发生和持续时间方面的差异，并确定两组患者都达到了相关基准（不稳定阶段在 90%的情况下在 3 天内得到解决）。
队列研究。
澳大利亚全国范围内的医院和社区的专科姑息治疗中心（2010 年 1 月 1 日至 2015 年 6 月 30 日）。
139556 名（1502 名原住民和 138054 名非原住民）成年患者。
在（1）阶段被归类为不稳定的风险，（2）不稳定阶段的持续时间，和（3）不稳定阶段延长（>3 天）的风险方面，比较原住民和非原住民患者。使用三级稳健泊松回归和互补对数离散时间生存模型生成了粗估计和调整估计。
不稳定阶段在原住民和非原住民患者中的总体发生率相似（调整后的相对风险 1.06；95%CI 1.00 至 1.11；在多次比较校正后无统计学意义）。不稳定阶段的持续时间和延长风险在两组患者中相似，各亚组之间无明显差异。两组患者均未达到基准（不稳定阶段持续时间>3 天的比例为 24.3% vs 25.5%；p=0.398）。
尽管澳大利亚原住民的医疗保健存在众所周知的缺陷，但在医院或社区接受专科姑息治疗服务的原住民患者中，并没有明显证据表明意外问题的发生或延长更为常见。
