2019冠状病毒病大流行之前及期间的预先护理计划：一项对73675份患者记录的观察性队列研究
Advance care planning before and during the COVID-19 pandemic: an observational cohort study of 73 675 patients' records.
作者信息
McFarlane Philippa G, Bunce Catey, Sleeman Katherine E, Orlovic Martina, Koffman Jonathan, Rosling John, Bearne Alastair, Powell Margaret, Riley Julia, Droney Joanne
机构信息
The Royal Marsden NHS Foundation Trust, London, UK
The Cicely Saunders Institute, King's College London, London, UK.
出版信息
BJGP Open. 2025 Jan 2;8(4). doi: 10.3399/BJGPO.2023.0145. Print 2024 Dec.
BACKGROUND
Advance care planning (ACP) was encouraged by policymakers throughout the COVID-19 pandemic. Little is known about use of ACP during this time.
AIM
To compare use of ACP before and during the COVID-19 pandemic.
DESIGN & SETTING: Retrospective, observational cohort study comparing the creation, use, and content of Electronic Palliative Care Coordination System (EPaCCS) records in London. Individuals aged ≥18 years with a Coordinate My Care record, created and published in the pre-pandemic period (1 January 2018-31 December 2019), wave 1 (W1; 20 March 2020-4 July 2020), interwave (IW; 5 July 2020-30 September 2020), and wave 2 (W2; 1 October 2020-5 March 2021).
METHOD
Patient demographics and components of ACP were compared using descriptive and comparative statistics.
RESULTS
In total, 73 675 records were included; 35 108 pre-pandemic, 21 235 W1, 6323 IW, and 9925 W2 ( = 1084 records not stratified as created and published in different periods). Most records were created in primary care (55.6% pre-pandemic, 75.5% W1, and 47.7% W2). Compared with the pre-pandemic period, the average weekly number of records created increased by 296.9% W1 (<0.005), 35.1% IW, and 29.1% W2 (<0.005). Patients with records created during the pandemic were younger (60.8% aged ≥80 years W1, 57.5% IW, 59.3% W2, 64.9% pre-pandemic [<0.005]). Patients with records created in W1 had longer estimated prognoses at record creation (73.3% had an estimated prognosis of ≥1 year W1 versus 53.3% pre-pandemic [<0.005]) and were more likely to be 'for resuscitation' (38.2% W1 versus 29.8% pre-pandemic [<0.005]).
CONCLUSION
During the COVID-19 pandemic increased ACP activity was observed, especially in primary care, for younger people and those not imminently dying. Further research is needed to identify training and planning requirements as well as organisational and system changes to support sustained high-quality ACP within primary care.
背景
在整个新冠疫情大流行期间，政策制定者鼓励进行预先护理计划（ACP）。对于这一时期ACP的使用情况，人们知之甚少。
目的
比较新冠疫情大流行之前和期间ACP的使用情况。
设计与设置
一项回顾性观察队列研究，比较伦敦电子姑息治疗协调系统（EPaCCS）记录的创建、使用和内容。纳入年龄≥18岁且有“协调我的护理”记录的个体，这些记录在大流行前时期（2018年1月1日至2019年12月31日）、第1波（W1；2020年3月20日至2020年7月4日）、波间期（IW；2020年7月5日至2020年9月30日）和第2波（W2；2020年10月1日至2021年3月5日）创建并发布。
方法
使用描述性和比较性统计方法比较患者人口统计学特征和ACP的组成部分。
结果
共纳入73675条记录；大流行前35108条，W1期21235条，IW期6323条，W2期9925条（=1084条记录未按在不同时期创建和发布进行分层）。大多数记录在初级保健机构创建（大流行前为55.6%，W1期为75.5%，W2期为47.7%）。与大流行前时期相比，每周创建的记录平均数量在W1期增加了296.9%（<0.005），IW期增加了35.1%，W2期增加了29.1%（<0.005）。在大流行期间创建记录的患者更年轻（W1期80岁及以上患者占60.8%，IW期占57.5%，W2期占59.3%，大流行前占64.9% [<0.005]）。在W1期创建记录的患者在创建记录时估计的预后时间更长（W1期73.3%的患者估计预后≥1年，而大流行前为53.3% [<0.005]），并且更有可能选择“进行心肺复苏”（W1期为38.2%，大流行前为29.8% [<0.005]）。
结论
在新冠疫情大流行期间，观察到ACP活动有所增加，尤其是在初级保健机构，针对的是年轻人和那些并非即将死亡的人。需要进一步研究以确定培训和规划要求以及组织和系统变革，以支持初级保健机构内持续的高质量ACP。
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