RESUMO
OBJETIVO: Valorar la necesidad potencial de cuidados paliativos durante el último mes de vida de una muestra de pacientes fallecidos en un hospital comarcal de Mallorca, y cuantificar los procesos diagnósticos y terapéuticos que reciben durante su estancia hospitalaria, estimando también el coste económico. MÉTODOS: Se realizó un estudio observacional retrospectivo sobre 119 pacientes fallecidos que cumplieron los criterios de inclusión. Un profesional experto en cuidados paliativos revisó la historia clínica cuantificando el uso de servicios y los procedimientos aplicados. Para la estimación de los costes se utilizaron los Grupos Relacionados con el Diagnóstico. RESULTADOS: El análisis de datos se realizó sobre 62 mujeres y 57 hombres, con una edad media de 78,15 ± 12,62 años. La prevalencia de pacientes fallecidos que cumplieron criterios de necesidad de atención paliativa fue del 88,81 %, con una identificación previa de pacientes paliativos del 6,7 %. El cáncer apareció como diagnóstico en 44 casos. La media de pruebas de imagen realizadas fue de 3,61 ± 2,70, analíticas de sangre de 7,46 ± 7,69 y tratamientos con antibióticos de 1,51 ± 1,60. El coste total medio de la atención prestada a la muestra fue de 5.662,44 €. CONCLUSIONES: Los resultados evidencian la elevada prevalencia de pacientes con necesidad de atención paliativa entre el total de fallecidos y una baja identificación previa. Se observa una alta frecuentación de los servicios hospitalarios y una alta aplicación de procedimientos invasivos en el último mes de vida, con el elevado coste económico y potencial de sufrimiento que supone
OBJECTIVE: To assess the potential need for palliative care during the last month of life in patients who passed away at a regional hospital in Mallorca, and to quantify the diagnostic and therapeutic procedures they underwent during their stay with an estimation of the costs incurred. METHODS: A retrospective observational study was conducted on 119 deceased patients meeting the inclusion criteria. An expert in palliative care reviewed their medical records and quantified the services and procedures that were provided. Costs were estimated based on diagnosisrelated groups (DRGs). RESULTS: Data were analyzed for 62women and 57 men, with a mean age of 78.15 ± 12.62 years. The prevalence of deceased patients who met the criteria for palliative care need was 88.81 %, with prior identification of palliative patients at 6.7 %. Cancer was found to be the diagnosis in 44 cases. The mean number of imaging tests was 3.61 ± 2.70, that of blood tests was 7.46 ± 7.69, and that of antibiotic treatments was 1.51 ± 1.60. The average total cost of care was € 5,662.44. CONCLUSIONS: Our results reveal a high prevalence of patients with palliative care need among the total number of deceased subjects, and a low rate of prior identifications. Frequentation of hospital services was found to be high, as was the use of invasive procedures in the last month of life, which potentially entails high costs and patient suffering
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/epidemiologia , Cuidados Paliativos na Terminalidade da Vida , Avaliação da Deficiência , Doença Crônica/economia , Estudos Retrospectivos , Neoplasias/diagnóstico , Custos e Análise de CustoRESUMO
BACKGROUND: The objective of the Balearic Islands Palliative Care (PC) Program is to improve the quality of PC through a shared model consisting of primary health care professionals, home-based PC teams, and PC units in hospitals. According to the World Health Organization (WHO), patients with advanced cancer and other terminal diseases benefit from early identification and proactive PC. We will evaluate the effectiveness of an intervention in which a PC leader is established in the primary health care center, and assess the effect of this intervention on the early identification of patients in need of PC, the efficient use of health care services, and direct health care costs. METHODS: Design: A two-arm cluster randomized clinical trial of 30 Primary Health Care Centers (PHCC) in Mallorca (Spain), in which each center was randomized to an intervention arm or a usual care arm. We expect that the number of patients identified as suitable for PC (including non-oncological PC) is at least 5% greater in the intervention arm. SAMPLE SIZE: A total of 4640 deceased patients. Outcomes will be assessed by a blinded external review of the electronic records. INTERVENTIONS: General practitioners (GPs) and nurse leaders in PC for each PHCC will be appointed. These leaders will help promote PC training of colleagues, improve symptom management and psychological support of patients, and evaluate the complexity of individual cases so that these cases receive assistance from PC home-based teams. MEASUREMENTS: Early identification (>90 days before death), evaluation of case complexity, level of case complexity (with referral to a home-based PC team), use and cost of hospital and primary care services, and quality of life during the last month of life (≥2 emergency room visits, ≥2 hospital admissions, ≥14 days of hospitalization). DISCUSION: PC leaders in primary care teams will improve the early identification of patients eligible for PC. This initiative could improve the quality of end-of-life care and utilization of hospital resources. TRIAL REGISTRATION: ISRCTN Registry identifier: ISRCTN92479122 . Retrospectively registered on 28 February 2017.
