Department of Epidemiology and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany.
BMC Palliat Care. 2021 Apr 13;20(1):59. doi: 10.1186/s12904-021-00751-0.
The goal of palliative care is to prevent and alleviate a suffering of incurable ill patients. A continuous intersectoral palliative care is important. The aim of this study is to analyse the continuity of palliative care, particularly the time gaps between hospital discharge and subsequent palliative care as well as the timing of the last palliative care before the patient's death.
The analysis was based on claims data from a large statutory health insurance. Patients who received their first palliative care in 2015 were included. The course of palliative care was followed for 12 months. Time intervals between discharge from hospital and first subsequent palliative care as well as between last palliative care and death were analysed. The continuity in palliative care was defined as an interval of less than 14 days between palliative care. Data were analysed using descriptive statistics and Chi-Square.
In 2015, 4177 patients with first palliative care were identified in the catchment area of the statutory health insurance. After general inpatient palliative care, 415 patients were transferred to subsequent palliative care, of these 67.7% (n = 281) received subsequent care within 14 days. After a stay in a palliative care ward, 124 patients received subsequent palliative care, of these 75.0% (n = 93) within 14 days. Altogether, 147 discharges did not receive subsequent palliative care. During the 12-months follow-up period, 2866 (68.7%) patients died, of these 78.7% (n = 2256) received palliative care within the last 2 weeks of life. Of these, 1223 patients received general ambulatory palliative care, 631 patients received specialised ambulatory palliative care, 313 patients received their last palliative care at a hospital and 89 patients received it in a hospice.
The majority of the palliative care patients received continuous palliative care. However, there are some patients who did not receive continuous palliative care. After inpatient palliative care, each patient should receive a discharge management for a continuation of palliative care. Readmissions of patients after discharge from inpatients palliative care can be an indication for a lack of support in the ambulatory health care setting and for an insufficient discharge management. Palliative care training and possibilities for palliative care consultations by specialists should strengthen the GPs in palliative care.
姑息治疗的目标是预防和减轻绝症患者的痛苦。持续的跨部门姑息治疗很重要。本研究的目的是分析姑息治疗的连续性，特别是患者出院后和随后的姑息治疗之间的时间间隔，以及患者死亡前最后一次姑息治疗的时间。
该分析基于一项大型法定健康保险的索赔数据。纳入 2015 年首次接受姑息治疗的患者。随访患者姑息治疗 12 个月。分析出院后和首次后续姑息治疗之间以及最后一次姑息治疗和死亡之间的时间间隔。姑息治疗的连续性定义为姑息治疗之间的间隔小于 14 天。使用描述性统计和卡方检验分析数据。
2015 年，在法定健康保险的承保区域内确定了 4177 名首次接受姑息治疗的患者。在接受一般住院姑息治疗后，415 名患者转至后续姑息治疗，其中 67.7%（n=281）在 14 天内接受后续治疗。在姑息治疗病房住院后，124 名患者接受了后续姑息治疗，其中 75.0%（n=93）在 14 天内接受了治疗。总共 147 名出院患者未接受后续姑息治疗。在 12 个月的随访期间，2866 名（68.7%）患者死亡，其中 78.7%（n=2256）在生命的最后 2 周内接受姑息治疗。其中，1223 名患者接受了一般门诊姑息治疗，631 名患者接受了专门的门诊姑息治疗，313 名患者在医院接受了最后一次姑息治疗，89 名患者在临终关怀院接受了姑息治疗。
大多数姑息治疗患者接受了连续的姑息治疗。然而，也有一些患者没有接受连续的姑息治疗。在接受住院姑息治疗后，每位患者都应接受出院管理以继续姑息治疗。从住院姑息治疗出院后再次入院可能表明在门诊保健环境中支持不足，以及出院管理不善。姑息治疗培训和专家姑息治疗咨询的可能性应加强全科医生在姑息治疗方面的能力。
