Nalugya Linda Grace, Harborne Derek, Reid Eleanor
Department of Emergency Medicine, Faculty of Medicine, Mbarara University School of Technology, Mbarara, Uganda.
Department of Emergency Medicine, Yale University School of Medicine, New Haven, USA.
Afr J Emerg Med. 2021 Dec;11(4):442-446. doi: 10.1016/j.afjem.2021.06.005. Epub 2021 Oct 28.
The Emergency Department (ED) of Mbarara Regional Referral Hospital serves a largely rural population of 4 million people in western Uganda. Here, ED patients with incurable illness often have prolonged stays. Palliative care (PC) is a low-cost intervention that focuses on alleviating pain and suffering for patients with incurable disease, while improving satisfaction with care and optimizing healthcare utilization. This is especially important in low resource settings. A prior needs assessment in our ED revealed that 50% of patients have PC needs. The ED is an optimal location to initiate PC, yet this rarely happens. There is a great need to identify factors affecting initiation of ED PC in our resource-limited setting.
A semi-structured questionnaire and chart review was conducted from March to August 2020. Patients admitted from the ED were assessed for PC needs. Those who met criteria were approached for inclusion and flagged for initiation of PC. The follow-up period was 7 days.
Sixty two percent of those subjects flagged for initiation of PC received it. By day seven, 36.1 of the study population had died. ED initiation of PC varied significantly by diagnosis, with cancer patients more likely to receive PC ( = 0.0097).
Important barriers to PC initiation were identified in our Ugandan ED, related to diagnosis. These barriers could be overcome by improving awareness of PC amongst patients and providers alike and implementing a PC screening tool for all admissions. Future research is needed to identify other barriers, as well as strategies for improved hospital-wide uptake of PC in this resource-limited setting.
姆巴拉拉地区转诊医院急诊科服务于乌干达西部约400万农村人口。在这里，患有不治之症的急诊科患者往往住院时间较长。姑息治疗是一种低成本干预措施，专注于减轻不治之症患者的疼痛和痛苦，同时提高护理满意度并优化医疗资源利用。这在资源匮乏地区尤为重要。我们急诊科先前的需求评估显示，50%的患者有姑息治疗需求。急诊科是启动姑息治疗的理想场所，但这种情况很少发生。在我们资源有限的环境中，迫切需要确定影响急诊科启动姑息治疗的因素。
2020年3月至8月进行了半结构化问卷调查和病历审查。对从急诊科收治的患者进行姑息治疗需求评估。符合标准的患者被纳入研究并标记为启动姑息治疗。随访期为7天。
标记为启动姑息治疗的受试者中有62%接受了该治疗。到第7天，研究人群中有36.1%的人死亡。急诊科启动姑息治疗因诊断不同而有显著差异，癌症患者更有可能接受姑息治疗（=0.0097）。
在我们乌干达的急诊科确定了启动姑息治疗的重要障碍，与诊断有关。通过提高患者和医护人员对姑息治疗的认识，并为所有入院患者实施姑息治疗筛查工具，可以克服这些障碍。需要进一步研究以确定其他障碍，以及在这种资源有限的环境中提高全院姑息治疗使用率的策略。
