Bornemann Reinhard, Kravets Ludmila, Lux Eberhard A
Innere Klinik, Universitätsklinikum Ostwestfalen-Lippe, Campus Klinikum Bielefeld, Bielefeld, Deutschland.
Klinik für Schmerz- und Palliativmedizin, Katholische St. Paulus Gesellschaft, St. Marien Hospital Lünen-Werne, Lünen, Deutschland.
MMW Fortschr Med. 2024 Apr;166(Suppl 4):19-26. doi: 10.1007/s15006-024-3719-4.
In Westphalia-Lippe - unlike the rest of Germany - outpatient palliative care, as general and specialized palliative care (AAPV and SAPV), exists as part of an innovative care model. Ten years after its introduction, an evaluation is to be carried out, focusing on the treatment satisfaction of patients and their relatives as well as the extent to which the model has proved successful in urban versus rural care contexts.
In a multicenter cohort study, in 2019/20, from a total of 36 palliative care regions, 12 - 4 metropolitan, mixed and rural each - were randomly selected, with 20 palliative patients each. Using established instruments (MIDOS, HOPE), the patients were questioned about stressful symptoms and quality of life. Additionally, their relatives were asked about their satisfaction with the care provided.
227 patients were included. The care period was 82.3 days on average (median 47.5). Distressing symptoms were consistently well controlled with a slight tendency for symptoms to increase at the end of life (NRS < 4). There were no significant differences between urban and rural regions. The outpatient palliative care provided by doctors and nurses in Westphalia-Lippe was largely viewed positively by the relatives.
In Westphalia-Lippe, patients in need of palliative care can be offered early and low- threshold structured outpatient palliative care, which is mainly provided by GPs and outpatient specialists. The role of the GP in primary medical care is being strengthened. In this interprofessional and interdisciplinary model, patient care is demand-oriented, that is, the intensity of care can switch between general (AAPV) and specialized care (SAPV) according to the disease progress. This model has proven itself in practice and provides good services benefits for palliative patients and their relatives.
在威斯特法伦-利珀地区——与德国其他地区不同——门诊姑息治疗，作为普通和专科姑息治疗（AAPV和SAPV），是一种创新护理模式的一部分。在其引入十年后，将进行一项评估，重点关注患者及其亲属的治疗满意度，以及该模式在城市与农村护理环境中取得成功的程度。
在一项多中心队列研究中，2019/20年，从总共36个姑息治疗区域中，随机选择12个——4个大城市、4个混合地区和4个农村地区——每个地区有20名姑息治疗患者。使用既定工具（MIDOS、HOPE），询问患者有关应激症状和生活质量的问题。此外，还询问了他们的亲属对所提供护理的满意度。
纳入了227名患者。护理期平均为82.3天（中位数47.5天）。痛苦症状始终得到良好控制，在生命末期症状有轻微增加的趋势（数字评定量表<4）。城市和农村地区之间没有显著差异。威斯特法伦-利珀地区医生和护士提供的门诊姑息治疗在很大程度上得到了亲属的积极评价。
在威斯特法伦-利珀地区，可以为需要姑息治疗的患者提供早期且门槛较低的结构化门诊姑息治疗，主要由全科医生和门诊专科医生提供。全科医生在初级医疗保健中的作用正在得到加强。在这种跨专业和跨学科模式中，患者护理以需求为导向，即护理强度可以根据疾病进展在普通（AAPV）和专科护理（SAPV）之间切换。该模式在实践中已得到验证，为姑息治疗患者及其亲属提供了良好的服务效益。
