Improving Advance Care Planning in a Resident Primary Care Clinic
Improving Advance Care Planning in a Resident Primary Care Clinic
复制标题
DOI：
10.1177/1049909119872757
复制
发表时间：
2019-09-02
影响因子：
1.9
通讯作者：
Duffy, Christine M.
中科院分区：
文献类型：
--
作者：
Nassikas, Nicholas J.;Baird, Grayson L.;Duffy, Christine M.
简介：三分之二的慢性病患者没有预先指示。本研究的主要目的是开发一种干预措施，以增加在内科住院初级保健诊所的老年人预先指示的文件。第二个目的是提高居民的信心，讨论提前护理规划，并增加讨论的数量。方法：本研究为干预前后研究。研究干预措施是一次30分钟的关于提前护理计划的教育会议。研究参与者是65岁及以上的患者，他们在内科住院医师初级保健诊所就诊超过6个月，并且是内科住院医师。在干预之前和之后，对诊所遇到的预先护理计划讨论进行了审查。居民的信心是衡量一个李克特规模。结果如下：2017年1月1日至2017年6月30日期间，在诊所中观察了295例合格患者，并将其纳入2017年至2018年期间进行的分析。记录的预先护理计划讨论的平均数量从干预前的2.24（95%置信区间[CI]：1.0-4.9）增加到干预后的8.94（95% CI：5.94-13.24）（P = 0.0011）。干预后，居民总体报告增加了讨论提前护理计划的信心。结论：一个相对温和的干预措施，以增加提前护理计划的讨论是可行的，在内科初级保健诊所，可以提高居民的信心与生命结束的讨论。
Introduction: Two-thirds of chronically ill patients do not have an advance directive. The primary aim of this study was to develop an intervention to increase the documentation of advance directives in elderly adults in an internal medicine resident primary care clinic. The secondary aims were to improve resident confidence in discussing advance care planning and increase the number of discussions. Methods: The study was a pre- and postintervention study. The study intervention was a 30-minute educational session on advance care planning. Study participants were patients aged 65 years and older who were seen in an internal medicine residency primary care clinic over a 6-month period and internal medicine residents. Clinic encounters were reviewed for the presence of advance care planning discussions before and after the intervention. Resident confidence was measured on a Likert scale. Results: Two hundred ninety-five eligible patients were seen in the clinic from January 1, 2017, to June 30, 2017, and included in the analysis performed between 2017 and 2018. The mean number of documented advance care planning discussions increased from 2.24 (95% confidence interval [CI]: 1.0-4.9) during the preintervention period to 8.94 (95% CI: 5.94-13.24]) during the postintervention period (P = .0011). Following the intervention, residents overall reported increased confidence in discussing advance care planning. Conclusion: A relatively modest intervention to increase advance care planning discussions is feasible in an internal medicine primary care clinic and can improve the confidence of residents with end-of-life discussion.