Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany.
Center for Clinical Studies, Jena University Hospital, Jena, Germany.
Palliat Med. 2021 Jun;35(6):1158-1169. doi: 10.1177/02692163211013666.
Comparative effectiveness of different types of palliative homecare is sparsely researched internationally-despite its potential to inform necessary decisions in palliative care infrastructure development. In Germany, specialized palliative homecare delivered by multi-professional teams has increased in recent years and factors beyond medical need seem to drive its involvement and affect the application of primary palliative care, delivered by general practitioners who are supported by nursing services.
To compare effectiveness of primary palliative care and specialized palliative homecare in reducing potentially aggressive interventions at the end-of-life in cancer and non-cancer.
Retrospective population-based study with claims data from 95,962 deceased adults in Germany in 2016 using multivariable regression analyses.
SETTINGS/PARTICIPANTS: Patients having received primary palliative care or specialized palliative homecare (alone or in addition to primary palliative care), for at least 14 days before death, differentiating between cancer and non-cancer patients.
Rates of potentially aggressive interventions in most indicators were higher in primary palliative care than in specialized palliative homecare ( < 0.01), in both cancer and non-cancer patients: death in hospital (odds ratio (OR) 4.541), hospital care (OR 2.720), intensive care treatment (OR 6.749), chemotherapy (OR 2.173), and application of a percutaneous endoscopic gastrostomy (OR 4.476), but not for parenteral nutrition (OR 0.477).
Specialized palliative homecare is more strongly associated with reduction of potentially aggressive interventions than primary palliative care in the last days of life. Future research should identify elements of specialized palliative homecare applicable for more effective primary palliative care, too. German Clinical Trials Register (DRKS00014730).
不同类型的姑息治疗家庭护理的比较效果在国际上研究甚少——尽管它有可能为姑息治疗基础设施的发展提供必要的决策依据。在德国，近年来多专业团队提供的专业姑息治疗家庭护理有所增加，而且似乎有超越医疗需求的因素驱动其介入，并影响由接受护理服务支持的全科医生提供的初级姑息治疗的应用。
比较初级姑息治疗和专业姑息治疗家庭护理在减少癌症和非癌症患者生命末期潜在侵袭性干预的效果。
使用多变量回归分析，对 2016 年德国 95962 名已故成年人的索赔数据进行回顾性基于人群的研究。
设置/参与者：患者接受初级姑息治疗或专业姑息治疗家庭护理（单独或与初级姑息治疗相结合）至少 14 天，区分癌症和非癌症患者。
在大多数指标中，初级姑息治疗的潜在侵袭性干预率高于专业姑息治疗家庭护理（均<0.01），在癌症和非癌症患者中：医院死亡（优势比（OR）4.541）、医院护理（OR 2.720）、重症监护治疗（OR 6.749）、化疗（OR 2.173）和经皮内镜胃造口术（OR 4.476），但不是肠外营养（OR 0.477）。
与初级姑息治疗相比，专业姑息治疗家庭护理在生命的最后几天与减少潜在侵袭性干预的相关性更强。未来的研究应确定专业姑息治疗家庭护理中适用于更有效的初级姑息治疗的元素。德国临床试验注册处（DRKS00014730）。
