Prevalence and Characteristics of Patients Being at Risk of Deteriorating and Dying in Primary Care
Prevalence and Characteristics of Patients Being at Risk of Deteriorating and Dying in Primary Care
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DOI：
10.1016/j.jpainsymman.2018.11.006
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发表时间：
2019-02-01
影响因子：
4.7
通讯作者：
Kizawa, Yoshiyuki
中科院分区：
文献类型：
--
作者：
Hamano, Jun;Oishi, Ai;Kizawa, Yoshiyuki
语境。了解初级保健门诊患者面临病情恶化和死亡风险的患病率和特征，可以让全科医生 (GP) 识别他们并启动临终讨论。 目标。本研究旨在调查由支持性和姑息治疗指标工具 (SPICT (TM)) 确定的初级保健门诊患者面临病情恶化和死亡风险的患病率和特征。方法。一项多中心横断面观察研究在 17 个诊所、22 名全科医生进行。我们招募了所有在 2017 年 3 月去看全科医生的年龄 >= 65 岁的患者。我们使用日本版 SPICT 来识别有病情恶化和死亡风险的患者。我们评估了入组患者的人口统计学和临床特征。结果。总共有 382 名平均年龄为 77.4 +/- 7.9 岁的患者接受了调查。 66 名患者 (17.3%) 在 SPICT-JP 中具有≥ 2 个阳性一般指标或≥ 1 个阳性疾病特异性指标。患有痴呆/虚弱、神经系统疾病、癌症和肾脏疾病的患者病情恶化和死亡的风险显着升高，而患有其他特定疾病的患者则没有。处于危险中的患者年龄明显较大，并且不太可能与家人一起生活在家里。他们的查尔森合并症指数得分也较高，姑息性能量表得分较低。结论。在65岁以上的初级保健门诊患者中，无论预计生存时间如何，17.3%的人面临病情恶化和死亡的风险，而且许多面临风险的门诊患者没有接受最佳的多学科护理。 (C) 2018 年美国临终关怀和姑息医学学会。由爱思唯尔公司出版。保留所有权利。
Context. Understanding the prevalence and characteristics of primary care outpatients being at risk of deteriorating and dying may allow general practitioners (GPs) to identify them and initiate end-of-life discussions.Objectives. This study aimed to investigate the prevalence and characteristics of primary care outpatients being at risk of deteriorating and dying, as determined by the Supportive and Palliative Care Indicators Tool (SPICT (TM)).Methods. A multicenter cross-sectional observational study was conducted at 17 clinics with 22 GPs. We enrolled all patients aged >= 65 years who visited the GPs in March 2017. We used the Japanese version of the SPICT to identify patients being at risk of deteriorating and dying. We assessed the demographic and clinical characteristics of enrolled patients.Results. In total, 382 patients with a mean age of 77.4 +/- 7.9 years were investigated. Sixty-six patients (17.3%) had >= 2 positive general indicators or >= 1 positive disease-specific indicator in the SPICT-JP. Patients with dementia/frailty, neurological disease, cancer, and kidney disease showed a significantly elevated risk of deteriorating and dying, whereas patients with other specific disease did not. The patients at risk were significantly older and less likely to be living with family at home. They also had a higher Charlson Comorbidity Index score and a lower Palliative Performance Scale score.Conclusion. Among primary care outpatients aged over 65 years, 17.3% were at risk of deteriorating and dying regardless of their estimated survival time, and many outpatients at risk were not receiving optimal multidisciplinary care. (C) 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.