Hayashi Shinu, Shirahige Yutaka, Fujioka Satoshi, Tsugihashi Yukio, Iida Hidezaku, Hirose Misaki, Yasunaka Masakazu, Kurita Noriaki
You Home Clinic, Bunkyo City, Japan.
You Home Clinic Heiwadai, Nerima City, Japan.
Fam Pract. 2023 Mar 28;40(2):211-217. doi: 10.1093/fampra/cmac062.
There is a growing need to realize high-quality end-of-life care at home that respects the patient's wishes.
To examine the association between the quality of primary care and advance care planning (ACP) participation among patients receiving home-based medical care.
In this multicentre, cross-sectional study, 29 home medical care clinics in Japan were included. Adult Japanese patients receiving home medical care were surveyed to assess their consideration of ACP. The quality of primary care, which reflects patient-centredness, was assessed with the Japanese version of the Primary Care Assessment Tool-Short Form (JPCAT-SF). Information on the clinical conditions that require home medical care was collected from physicians.
Of the 194 patients surveyed from 29 home medical services, 62 patients (32%) showed signs of ACP participation. Lack of opportunities was the most common reason for not participating in the ACP. In a multivariable-adjusted generalized estimating equation, primary care quality was associated with ACP participation (per 10-point increase, adjusted odds ratio: 1.96, 95% confidence interval: 1.51-2.56). In addition, all domains of the JPCAT-SF were associated with ACP participation.
Patient-centredness in home medical care facilitates the initiation of ACP participation.
越来越需要在家中实现尊重患者意愿的高质量临终关怀。
研究接受居家医疗护理的患者中初级护理质量与预先护理计划（ACP）参与度之间的关联。
在这项多中心横断面研究中，纳入了日本的29家家庭医疗诊所。对接受居家医疗护理的成年日本患者进行调查，以评估他们对ACP的考虑情况。使用初级护理评估工具简表（JPCAT-SF）的日语版本评估反映以患者为中心的初级护理质量。从医生那里收集有关需要居家医疗护理的临床状况的信息。
在从29项家庭医疗服务中调查的194名患者中，有62名患者（32%）表现出参与ACP的迹象。缺乏机会是未参与ACP的最常见原因。在多变量调整的广义估计方程中，初级护理质量与ACP参与度相关（每增加10分，调整后的优势比：1.96，95%置信区间：1.51-2.56）。此外，JPCAT-SF的所有领域均与ACP参与度相关。
居家医疗护理中的以患者为中心有助于启动ACP参与。
