Many people in Scotland now benefit from anticipatory care before they die: an after death analysis and interviews with general practitioners
Many people in Scotland now benefit from anticipatory care before they die: an after death analysis and interviews with general practitioners
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DOI：
10.1136/bmjspcare-2015-001014
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发表时间：
2019-12-01
影响因子：
2.7
通讯作者：
Murray, Scott A.
中科院分区：
文献类型：
--
作者：
Tapsfield, Julia;Hall, Charlie;Murray, Scott A.
背景关键信息摘要（KIS）于2013年在苏格兰各地推出，以便全科医生（GP）撰写的预期护理计划可以在GP与计划外和二级护理提供者之间以电子方式定期共享并真实的更新。并探讨全科医生对使用KIS.Methods的看法，我们研究了2014年在9个不同的洛锡安实践中死亡的所有患者的初级保健记录。我们确定了是否已经开始了预期或姑息治疗，如果是的话，死亡前多少周以及治疗的哪些方面已经记录在案。我们采访了10个全科医生，了解障碍和促进factors.Results总体而言，60%的患者被确定为KIS，死亡前的中位数为18周。癌症患者的死亡率最高，为75%，而死于痴呆/虚弱的患者为66%，死于器官衰竭的患者仅为41%。如果患者有KIS，他们更有可能在医院外死亡。全科医生确定的专业，病人和社会的挑战，在确定姑息治疗的患者，特别是那些非癌症diagnosis.Conclusions全科医生确定患者的预期和姑息治疗更公平地跨越不同的疾病轨迹和早期的疾病过程比他们以前确定病人专门为姑息治疗。然而，许多患者仍然缺乏护理计划，特别是那些死于器官衰竭的患者。
Background Key Information Summaries (KIS) were introduced throughout Scotland in 2013 so that anticipatory care plans written by general practitioners (GPs) could be routinely shared electronically and updated in real time, between GPs and providers of unscheduled and secondary care.Aims We aimed to describe the current reach of anticipatory and palliative care, and to explore GPs' views on using KIS.Methods We studied the primary care records of all patients who died in 2014 in 9 diverse Lothian practices. We identified if anticipatory or palliative care had been started, and if so how many weeks before death and which aspects of care had been documented. We interviewed 10 GPs to understand barriers and facilitating factors.Results Overall, 60% of patients were identified for a KIS, a median of 18weeks before death. The numbers identified were highest for patients with cancer, with 75% identified compared with 66% of those dying with dementia/frailty and only 41% dying from organ failure. Patients were more likely to die outside hospital if they had a KIS. GPs identified professional, patient and societal challenges in identifying patients for palliative care, especially those with non-cancer diagnoses.Conclusions GPs are identifying patients for anticipatory and palliative care more equitably across the different disease trajectories and earlier in the disease process than they were previously identifying patients specifically for palliative care. However, many patients still lack care planning, particularly those dying with organ failure.