Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
BMC Palliat Care. 2022 Nov 15;21(1):197. doi: 10.1186/s12904-022-01098-w.
Several studies demonstrated that cancer patients visited the emergency department (ED) frequently. This indicates unmet needs and poor-quality palliative care. We aimed to investigate the factors that contribute to ED visits among patients with advanced cancer in order to identify strategies for reducing unnecessary ED visits among these patients.
A retrospective study was conducted between January and December, 2019. Eligible patients were previously enrolled in the comprehensive palliative care program prior to their ED visit. All patients older than 18 were included. Patients were excluded if they had died at the initial consultation, were referred to other programs at the initial consultation, or had an incomplete record. The trial ended when the patients died, were referred to other palliative programs, or the study ended. The time between the initial palliative consultation and study endpoints was categorized into three groups: 16 days, 16-100 days, and > 100 days, based on the literature review. To investigate the factors associated with ED visits, a logistic regression analysis was conducted. The variables with a P value < 0.15 from the univariate logistic regression analysis were included in the multiple logistic regression analysis.
Among a total of 227 patients, 93 visited the ED and 134 did not. Mean age was 65.5 years. Most prevalent cancers were colorectal (18.5%), lung (16.3%), and hepatobiliary (11.9%). At the end, 146 patients died, 45 were alive, nine were referred to other programs, and 27 were lost to follow-up. In univariate logistic regression analysis, patients with > 100 days from palliative consultation (OR 0.23; 95%CI 0.08, 0.66; p-value 0.01) were less likely to attend the ED. In contrast, PPS 50-90% (OR 2.02; 95%CI 1.18, 3.47; p-value 0.01) increased the ED visits. In the multiple logistic regression analysis, these two factors remained associated with ED visits:> 100 days from the palliative consultation (OR 0.18; 95%CI 0.06, 0.55; p-value 0.01) and PPS 50-90% (OR 2.62; 95%CI 1.44, 4.79; p-value 0.01).
There was reduced ED utilization among cancer patients with > 100 days of palliative care. Patients having a lower PPS were associated with a lower risk of ED visits.
多项研究表明，癌症患者经常到急诊科就诊。这表明存在未满足的需求和较差的姑息治疗质量。我们旨在调查导致晚期癌症患者到急诊科就诊的因素，以便确定减少这些患者不必要的急诊科就诊的策略。
本研究为回顾性研究，于 2019 年 1 月至 12 月进行。符合条件的患者在急诊科就诊前曾参加过全面的姑息治疗计划。所有年龄大于 18 岁的患者均纳入本研究。如果患者在初始咨询时死亡、在初始咨询时被转至其他计划或记录不完整，则将其排除在外。当患者死亡、被转至其他姑息治疗计划或研究结束时，试验结束。根据文献复习，将初始姑息治疗咨询和研究终点之间的时间分为三组：16 天、16-100 天和>100 天。为了调查与急诊科就诊相关的因素，进行了逻辑回归分析。单变量逻辑回归分析中 P 值<0.15 的变量被纳入多变量逻辑回归分析。
在总共 227 名患者中，93 名患者到急诊科就诊，134 名患者未到急诊科就诊。平均年龄为 65.5 岁。最常见的癌症为结直肠癌（18.5%）、肺癌（16.3%）和肝胆癌（11.9%）。最后，146 名患者死亡，45 名患者存活，9 名患者被转至其他计划，27 名患者失访。在单变量逻辑回归分析中，姑息治疗咨询后>100 天的患者（比值比 0.23；95%置信区间 0.08，0.66；p 值 0.01）到急诊科就诊的可能性较小。相比之下，PPS 50-90%（比值比 2.02；95%置信区间 1.18，3.47；p 值 0.01）增加了急诊科就诊次数。在多变量逻辑回归分析中，这两个因素仍然与急诊科就诊相关：姑息治疗咨询后>100 天（比值比 0.18；95%置信区间 0.06，0.55；p 值 0.01）和 PPS 50-90%（比值比 2.62；95%置信区间 1.44，4.79；p 值 0.01）。
姑息治疗后>100 天的癌症患者到急诊科就诊的次数减少。PPS 较低的患者到急诊科就诊的风险较低。
