Department of General Practice and Primary Care, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
Department of Health Economics and Health Care Research, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
Age Ageing. 2024 May 1;53(5). doi: 10.1093/ageing/afae100.
Patients with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and dementia are underrepresented in specialist palliative home care (SPHC). However, the complexity of their conditions requires collaboration between general practitioners (GPs) and SPHC teams and timely integration into SPHC to effectively meet their needs.
To facilitate joint palliative care planning and the timely transfer of patients with advanced chronic non-malignant conditions to SPHC.
A two-arm, unblinded, cluster-randomised controlled trial. 49 GP practices in northern Germany were randomised using web-based block randomisation. We included patients with advanced CHF, COPD and/or dementia. The KOPAL intervention consisted of a SPHC nurse-patient consultation followed by an interprofessional telephone case conference between SPHC team and GP. The primary outcome was the number of hospital admissions 48 weeks after baseline. Secondary analyses examined the effects on health-related quality of life and self-rated health status, as measured by the EuroQol 5D scale.
A total of 172 patients were included in the analyses. 80.4% of GP practices had worked with SHPC before, most of them exclusively for cancer patients. At baseline, patients reported a mean EQ-VAS of 48.4, a mean quality of life index (EQ-5D-5L) of 0.63 and an average of 0.80 hospital admissions in the previous year. The intervention did not significantly reduce hospital admissions (incidence rate ratio = 0.79, 95%CI: [0.49, 1.26], P = 0.31) or the number of days spent in hospital (incidence rate ratio = 0.65, 95%CI: [0.28, 1.49], P = 0.29). There was also no significant effect on quality of life (∆ = -0.02, 95%CI: [-0.09, 0.05], P = 0.53) or self-rated health (∆ = -2.48, 95%CI: [-9.95, 4.99], P = 0.51).
The study did not show the hypothesised effect on hospitalisations and health-related quality of life. Future research should focus on refining this approach, with particular emphasis on optimising the timing of case conferences and implementing discussed changes to treatment plans, to improve collaboration between GPs and SPHC teams.
充血性心力衰竭（CHF）、慢性阻塞性肺疾病（COPD）和痴呆症患者在专科姑息治疗家庭护理（SPHC）中代表性不足。然而，他们的病情复杂，需要全科医生（GP）和 SPHC 团队之间的合作，并及时纳入 SPHC，以有效满足他们的需求。
促进联合姑息治疗计划，并及时将患有晚期慢性非恶性疾病的患者转至 SPHC。
这是一项两臂、非盲、集群随机对照试验。德国北部的 49 家全科医生诊所采用基于网络的块随机化进行随机分组。我们纳入了患有晚期 CHF、COPD 和/或痴呆症的患者。KOPAL 干预措施包括 SPHC 护士与患者的咨询，以及 SPHC 团队与 GP 之间的跨专业电话病例会议。主要结局是基线后 48 周的住院人数。次要分析检查了对健康相关生活质量和自我评估健康状况的影响，采用 EuroQol 5D 量表进行评估。
共纳入 172 名患者进行分析。80.4%的全科医生诊所在之前曾与 SPHC 合作，其中大多数仅为癌症患者提供服务。在基线时，患者报告的平均 EQ-VAS 为 48.4，平均生活质量指数（EQ-5D-5L）为 0.63，去年平均住院 0.80 次。干预措施并未显著减少住院人数（发病率比=0.79，95%CI：[0.49, 1.26]，P=0.31）或住院天数（发病率比=0.65，95%CI：[0.28, 1.49]，P=0.29）。对生活质量也没有显著影响（∆=-0.02，95%CI：[-0.09, 0.05]，P=0.53）或自我评估健康状况（∆=-2.48，95%CI：[-9.95, 4.99]，P=0.51）。
该研究并未显示出假设的对住院和健康相关生活质量的影响。未来的研究应集中于完善这种方法，特别注重优化病例会议的时间，并实施治疗计划的讨论变更，以改善全科医生和 SPHC 团队之间的合作。
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