Survey of specialist palliative care and heart failure: September 2004
Survey of specialist palliative care and heart failure: September 2004
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DOI：
10.1177/0269216306071063
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发表时间：
2006-01-01
影响因子：
4.4
通讯作者：
Gibbs, J. Simon R.
中科院分区：
文献类型：
--
作者：
Gibbs, Louise M. E.;Khatri, Ajeet K.;Gibbs, J. Simon R.
目的：描述英国专家姑息治疗（SPC）服务的提供，和态度，心力衰竭患者，并确定在这一领域特别感兴趣或专业知识的发展。方法：2004年9月，对英国SPC服务的所有首席顾问进行邮政调查。结果如下：在397项服务中，有233项得到了回复（回复率为59%）; 222项（95%）认为SPC在重度/终末期心力衰竭中发挥作用，而3项（1%）则没有。共有197家（85%）接受心力衰竭患者，26家（11%）不接受。不接受心力衰竭患者的最常见原因是缺乏资源或床位，对员工培训或组织决策的影响。目前接受服务的心力衰竭患者平均人数为2.2人，但有15人接受了5人以上（最多53人）。15家服务机构（6%）对心力衰竭患者有特定的转诊标准，包括症状无改善的复发性住院、进一步住院的不适当性和心力衰竭的严重程度。12个服务机构（5%）已经或正在制定心力衰竭治疗指南：5个是生命终结途径，3个涉及呼吸困难管理，3个是症状控制指南。约137项服务（59%）描述了SPC、心力衰竭服务和初级保健之间的地方合作举措，如相互教育、联合工作和工作组。详细介绍了一些联合工作做法的模式。27人（12%）了解国家举措。结论：目前的情况下，SPC服务在英国的心力衰竭患者有很大的不同。在本次审计中，十分之一的SPC服务不接受心力衰竭患者。很少有公司开发出规模可观的服务。地方合作倡议很常见。已经制定了具体的转诊标准和症状控制指南。它们在促进心力衰竭患者良好姑息治疗中的作用尚不清楚。更好地传播这些举措所获得的实践知识，可以显着改善向心力衰竭患者提供SPC服务。
Aims: To describe English specialist palliative care (SPC) services' provision for, and attitude to, heart failure patients, and to identify developments of particular interest or expertise in this area. Method: Postal survey of all lead consultants of English SPC services, September 2004. Results: Of 397 services, 233 replied (response rate 59%); 222 (95%) thought SPC had a role in severe/end stage heart failure, while three (1%) did not. A total of 197 services (85%) accepted heart failure patients, 26 (11%) did not. The most common reasons for not accepting heart failure patients were lack of resources or beds, implications for staff training or an organizational decision. The mean number of heart failure patients currently under a service was 2.2, but 15 had more than five (maximum 53). Fifteen services (6%) had specific referral criteria for heart failure patients, including recurrent hospital admissions without symptomatic improvement, inappropriateness of further hospital admission and severity of heart failure. Twelve services (5%) had or were developing treatment guidelines for heart failure: five were end of life pathways, three covered breathlessness management and three were symptom control guidelines. Some 137 services (59%) described local collaborative initiatives between SPC, heart failure services and primary care, such as mutual education, joint working and working groups. A number of models of joint working practices were described in detail. Twenty-seven (12%) knew of national initiatives. Conclusions: The current situation of SPC services in England for patients with heart failure varies widely. One in 10 SPC services in this audit did not accept heart failure patients. Few have developed services of significant size. Local collaborative initiatives are common. Specific referral criteria and symptom control guidelines have been developed. Their role in promoting good palliative care in patients with heart failure remains unclear. Better dissemination of practical knowledge gained by these initiatives could significantly improve the provision of SPC services to heart failure patients.