Palliative Nexus Research Group, Department of Medicine, University of Melbourne, Melbourne, Australia.
Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, Australia.
Support Care Cancer. 2024 Apr 8;32(5):273. doi: 10.1007/s00520-024-08458-7.
Health service use is most intensive in the final year of a person's life, with 80% of this expenditure occurring in hospital. Close involvement of primary care services has been promoted to enhance quality end-of-life care that is appropriate to the needs of patients. However, the relationship between primary care involvement and patients' use of hospital care is not well described. This study aims to examine primary care use in the last year of life for cancer patients and its relationship to hospital usage.
Retrospective cohort study in Victoria, Australia, using linked routine care data from primary care, hospital and death certificates. Patients were included who died related to cancer between 2008 and 2017.
A total of 758 patients were included, of whom 88% (n = 667) visited primary care during the last 6 months (median 9.1 consultations). In the last month of life, 45% of patients were prescribed opioids, and 3% had imaging requested. Patients who received home visits (13%) or anticipatory medications (15%) had less than half the median bed days in the last 3 months (4 vs 9 days, p < 0.001, 5 vs 10 days, p = 0.001) and 1 month of life (0 vs 2 days, p = 0.002, 0 vs 3 days, p < 0.001), and reduced emergency department presentations (32% vs 46%, p = 0.006, 31% vs 47% p < 0.001) in the final month.
This study identifies two important primary care processes-home visits and anticipatory medication-associated with reduced hospital usage and intervention at the end of life.
人的生命最后一年的卫生服务利用率最高，其中 80%的支出发生在医院。为了提高符合患者需求的临终关怀质量，大力提倡基层医疗服务的密切参与。然而，基层医疗服务的参与和患者对医院护理的使用之间的关系尚未得到很好的描述。本研究旨在考察癌症患者生命最后一年的基层医疗服务使用情况及其与医院使用的关系。
在澳大利亚维多利亚州进行回顾性队列研究，使用基层医疗、医院和死亡证明的常规护理数据进行链接。纳入的患者在 2008 年至 2017 年间死于癌症相关疾病。
共纳入 758 例患者，其中 88%（n=667）在生命的最后 6 个月内就诊于基层医疗机构（中位数为 9.1 次就诊）。在生命的最后一个月，45%的患者开具了阿片类药物，3%的患者进行了影像学检查。接受家访（13%）或预开药物（15%）的患者在生命的最后 3 个月（中位数分别为 4 天和 9 天，p<0.001；5 天和 10 天，p=0.001）和最后 1 个月（中位数分别为 0 天和 2 天，p=0.002；0 天和 3 天，p<0.001）的住院天数减少，急诊就诊次数也减少（32%比 46%，p=0.006；31%比 47%，p<0.001）。
本研究确定了两个重要的基层医疗服务流程——家访和预开药物，这与生命末期减少医院使用和干预有关。
