Primary care continuity and location of death for those with cancer.
Primary care continuity and location of death for those with cancer.
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DOI：
10.1089/109662103322654794
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发表时间：
2003-12-01
影响因子：
2.8
通讯作者：
Cummings, Ina
中科院分区：
文献类型：
--
作者：
Burge, Frederick;Lawson, Beverley;Cummings, Ina
背景：众所周知，初级保健的连续性与改善的护理过程和结果有关。尽管连续性是临终关怀的理想属性，尽管大多数癌症患者希望在家中死亡，但还没有卫生服务研究来检验这种关系。目的：检查癌症患者的家庭医生连续性护理与死亡位置之间的关联。研究设计：一项基于人群的回溯性研究，涉及四个相互关联的行政健康数据库的二级数据分析，跨越6年的信息(1992-1997)。加拿大研究对象：所有1992-1997年间死于癌症且至少三次就诊于家庭医生的患者。方法：采用Logistic回归分析提供者连续性护理与院外死亡的关系。结果：在研究人群中9714例死亡病例中，院外死亡占31.6%。护理提供者的平均连续性为0.78(标准差[SD]0.22)。与院内死亡的患者相比，院外死亡的患者接受提供者连续性治疗的几率更高(调整后的优势比[OR]=1.54，95%可信区间[CI]=1.22，1.93)。这种影响似乎因性别而有所改变，发现男性与女性之间存在显著的关联。然而，对于男女来说，这一点估计的趋势是相似的。结论：这项研究表明，对于晚期癌症患者，家庭医生的连续性护理与死亡地点之间存在关联。在制定临终关怀综合服务提供模式时，应培养这种连续性。
BACKGROUND: Continuity of primary care is known to be associated with both improved processes and outcomes of care. Despite continuity being a desired attribute of end-of-life care and despite the desire by most patients with cancer to die at home, there has been no health services research examining this relationship.AIM: To examine the association between family physician continuity of care and the location of death for patients with cancer.DESIGN OF STUDY: A retrospective population-based study involving secondary data analysis of four linked administrative health databases spanning 6 years of information (1992-1997).SETTING: Nova Scotia, Canada Participants: All those who died of cancer from 1992 to 1997 and had made at least three ambulatory visits to a family physician.METHODS: The relationship of provider continuity of care and an out-of-hospital death was examined using logistic regression.RESULTS: Out-of-hospital deaths accounted for 31.6% of the 9714 deaths in the study population. The mean provider continuity of care was 0.78 (standard deviation [SD] 0.22). Those who died out-of-hospital had a greater odds of having received high provider continuity (adjusted odds ratio [OR] = 1.54, 95% confidence interval [CI] = 1.22, 1.93) when compared to those who died in-hospital. There appears to be a modification of this effect by gender with a significant association found for males and not for females. The trends in the point estimates are, however, similar for both sexes.CONCLUSIONS: This study demonstrates an association between family physician continuity of care and the location of death for those with advanced cancer. Such continuity should be fostered in the development of models of integrated service delivery for end-of-life care.