Rhee Joel, Carey Mariko, Zucca Alison, Lambkin David
The Discipline of General Practice, School of Population Health, Faculty of Medicine and Health, UNSW, Sydney, NSW, Australia; and General Practice Academic Unit, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.
School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia; and Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
Aust J Prim Health. 2023 Dec;29(6):637-642. doi: 10.1071/PY22227.
The 75+ health assessment has been identified as a suitable trigger to introduce advance care planning (ACP) to general practice patients. Australian general practitioners (GPs) were surveyed to explore their perceptions, attitudes and practices in introducing ACP during 75+ health assessments.
A cross-sectional postal survey of Australian GPs covering their personal, professional and workplace characteristics, their current practice regarding ACP within a 75+ health assessment, and their attitude towards ACP. Multivariate logistic regression was used to analyse the factors associated with routinely discussing ACP as part of the 75+ health assessment.
A total of 185 (19.2%) out of 964 eligible GPs returned a completed survey. Most GPs reported that patients interested in ACP were supported by the GPs or the practice nurse. Two factors, (1) attitude that ACP is an essential component of the 75+ health assessment, and (2) regional or rural location of the practice, had a statistically and clinically significant association with the GP's self-reported discussion of ACP during 75+ health assessments.
GPs showed a high level of support and involvement in discussing ACP during 75+ health assessments. ACP support during 75+ health assessments was often provided directly by the GP or via the practice nurse. Given the international evidence that ACP training programs improve skills and knowledge, and foster positive attitudes towards ACP, there is an important need to continue funding ACP training programs for GPs and practice nurses.
75岁及以上健康评估已被确定为向全科医疗患者引入预先护理计划（ACP）的合适契机。对澳大利亚全科医生（GP）进行了调查，以探讨他们在75岁及以上健康评估期间引入ACP的看法、态度和做法。
对澳大利亚全科医生进行横断面邮寄调查，内容涵盖他们的个人、专业和工作场所特征、他们在75岁及以上健康评估中目前关于ACP的做法以及他们对ACP的态度。采用多变量逻辑回归分析与将ACP作为75岁及以上健康评估一部分进行常规讨论相关的因素。
964名符合条件的全科医生中，共有185名（19.2%）返回了完整的调查问卷。大多数全科医生报告称，对ACP感兴趣的患者得到了全科医生或执业护士的支持。两个因素，（1）认为ACP是75岁及以上健康评估重要组成部分的态度，以及（2）诊所位于地区或农村，与全科医生在75岁及以上健康评估期间自我报告的关于ACP的讨论在统计学和临床上具有显著关联。
全科医生在75岁及以上健康评估期间讨论ACP时表现出高度的支持和参与。75岁及以上健康评估期间的ACP支持通常由全科医生直接提供或通过执业护士提供。鉴于国际上有证据表明ACP培训项目可提高技能和知识，并培养对ACP的积极态度，因此迫切需要继续为全科医生和执业护士的ACP培训项目提供资金。
