Palyatif bakım merkezinden evde bakıma taburcu edilen hastaların klinik özellikleri: retrospektif kesitsel bir çalışma

Year 2024, Volume: 6 Issue: 2, 155 - 160, 08.03.2024

Ümit Murat Parpucu , Kadriye Kahveci , Cihan Döğer , Semih Aydemir , Onur Küçük

https://doi.org/10.38053/acmj.1423588

Abstract

Amaç: Bu çalışmanın amacı, palyatif bakım merkezinden (PCC) evde bakıma (HC) taburcu edilen hastaların klinik özelliklerini ve bunların kalış süresine (LOS) etkisini belirlemektir.
Yöntemler: Kesitsel çalışmamız, 1 Ocak 2015 ile 30 Eylül 2018 tarihleri arasında PCC'den HC'ye taburcu edilen 314 hastayı retrospektif olarak analiz etti. Hastalar, PCC'deki LOS'lerine göre iki gruba ayrıldı. Uzamış hastanede yatış, 30 günden fazla hastanede yatış olarak tanımlandı. Uzun süreli hastanede kalışla ilişkili klinik özellikler analiz edildi.
Bulgular: Çalışmaya 129'u (%41,08) kadın, 185'i (%58,92) erkek olmak üzere 314 hasta dahil edildi. Ortalama yaş 68,41±18,91 yıl ve PCC'de kalış süresi 36,27±40,34 gündü. Hastalardan 186'sı 30 gün ve daha az, 128'i ise 30 günden fazla hastanede yattı. En sık görülen tanı serebrovasküler olay (CVE) (%37,57) idi. Eşlik eden kronik sistemik hastalıkların en sık hipertansiyon (%20,70) olduğu, bunu sırasıyla diyabet ve kalp yetmezliğinin (%9,87; %6,68) takip ettiği görüldü. Toplam hasta sayısının %9,87'si (n = 31) mobilize idi. Bunların %55,09'u (n=173) oral beslenme alabiliyordu, %42,03'ü (n=132) perkütan endoskopik gastrostomi (PEG), %23,88'i (n=75) bası yarası (PU), %27,07'si (n=132) n=85) trakeostomi mevcuttu. Ayrıca hastaların %6,68'i (n=24) ev ventilatörü ile solunum desteği alıyordu. Mobilize, ağızdan beslenebilen ve kanser tanısı alan hastaların hastanede kalış süresinin daha kısa olduğu görüldü. CVE (p=0,001), kafa travması (p=0,013), hipoksik beyin tanısı (p=0,001), PEG (p<0,001), trakeostomi (p<0,001), PU (p=0,011) ve ev ventilatörü (p=0,024) uzun LOS'nin belirleyicileri olarak belirlendi. Hipoksik beyin tanısının, uzun süreli hastanede yatışla (OR:6,8) en güçlü şekilde ilişkili klinik özellik olduğu, bunu PEG beslemesi (OR:6,6) ve trakeostomi varlığının (OR:5,2) takip ettiği görüldü.
Tartışma: Çalışmamızda trakeostomi, PEG ve PU bulunan hastaların bakım ve beslenme eğitimi nedeniyle taburculuk sürelerinin uzadığını gözlemledik.

Keywords

palyatif bakım, Evde bakım, yatış süresi, taburculuk, uzun süreli hastanede kalma

Clinical characteristics of patients discharged from a palliative care center to home care: a retrospective cross-sectional study

Abstract

Aims: The aim of this study was to establish the clinical characteristics and their impact on the length of stay (LOS) of patients discharged from a palliative care center (PCC) to home care (HC).
Methods: Our cross-sectional study retrospectively analysed 314 patients who were discharged from PCC to HC between 1 January 2015 and 30 September 2018. The patients were divided into two groups based on their LOS in the PCC. Prolonged hospitalisation was defined as hospitalisation for more than 30 days. Clinical characteristics associated with prolonged hospitalization were analyzed.
Results: The study included 314 patients, with 129 (41.08%) female and 185 (58.92%) male. The mean age was 68.41±18.91 years and the LOS in PCC was 36.27±40.34 days. Of the patients, 186 were hospitalized for 30 days or less, while 128 were hospitalized for more than 30 days. The most frequent diagnosis was cerebrovascular event (CVE) (37.57%). The most common accompanying chronic systemic diseases were hypertension (20.70%), followed by diabetes mellitus and heart failure (9.87%; 6.68%, respectively). Out of the total number of patients, 9.87% (n=31) were mobilized. Among them, 55.09% (n=173) were able to receive oral nutrition, 42.03% (n=132) had percutaneous endoscopic gastrostomy (PEG), 23.88% (n=75) had pressure ulcer (PU), and 27.07% (n=85) had tracheostomy. Additionally, 6.68% (n=24) of the patients were receiving respiratory support with a home ventilator. It was observed that the LOS of patients who were mobile, able to feed orally, and diagnosed with cancer was shorter. The presence of CVE (p=0.001), head trauma (p=0.013), hypoxic brain diagnosis (p=0.001), PEG (p<0.001), tracheostomy (p<0.001), PU (p=0.011), and home ventilator (p=0.024) were identified as predictors of long LOS. Hypoxic brain diagnosis was found to be the clinical feature most strongly associated with long-term hospitalization (OR:6.8), followed by PEG feeding (OR:6.6) and the presence of tracheostomy (OR:5.2).
Conclusion: In our study we observed that time to discharge is extended due to training on care and nutrition for patients undergoing tracheostomy, PEG and PU.

Keywords

Palliative care, home care, length of stay, discharge, prolonged hospitalisation

Ethical Statement

Approval was obtained from the ethics committee at the University of Health Sciences, Ankara Numune SUAM Clinical Research (protocol number 2625/2019; dated 28/03/2019).

Supporting Institution

None.

Thanks

None.

References

• Christensen K, Doblhammer G, Rau R, Vaupel JW. Ageing populations: the challenges ahead. Lancet. 2009;374(9696):1196-208.
• Radbruch L, Payne S. White paper on standards and norms for hospice and palliative care in Europe: part 1. Eur J Palliat Care. 2009;16(6):278-289.
• Nelson JE, Cox CE, Hope AA, Carson SS. Chronic critical illness. Am J Respir Crit Care Med. 2010;182(4):446-454.
• Parpucu ÜM, Küçük O, Sağ F, et al. Pre-assessment criteria for the needs of patients in palliative care: the role of palliative care by age groups. Turkish J Geriatr. 2023;26(3):334-346.
• Ibrahim JE, Anderson LJ, MacPhail A, Lovell JJ, Davis MC, Winbolt M. Chronic disease self-management support for persons with dementia, in a clinical setting. J Multidiscip Healthc. 2017;10:49-58.
• Wiencek C, Coyne P. Palliative care delivery models. Semin Oncol Nurs. 2014;30(4):227-233.
• Reymond L, Parker G, Gilles L, Cooper K. Home-based palliative care. Aust J Gen Pract. 2018;47(11):747-752.
• Ozgul N, Koc O, Gultekin M, et al. Opioids for cancer pain: availability, accessibility, and regulatory barriers in Turkiye and Pallia-Turk Project. J Pediatr Hematol Oncol. 2011;33:S29-S32.
• Ozgul N, Gultekin M, Koc O, et al. Turkish community-based palliative care model: a unique design. Ann Oncol. 2012;23(Supplement 3):iii76-iii78.
• Mergen H, Unluoglu I, Elcioglu O. Contemporary home care service and family medicine in Turkiye. Home Health Care Manag Pract. 2013;25(3):104-109.
• Emuk Y, Naz I. The current situation of palliative care in Turkiye. J Cancer Policy. 2017;13:33-37.
• Radbruch L, Maier BO, Bausewein C. Palliative home care: which type for whom and when? Schmerz. 2019;33(4):285-286.
• Brumley R, Enguidanos S, Jamison P, et al. Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care. J Am Geriatr Soc. 2007;55(7):993-1000.
• Ciemins EL, Stuart B, Gerber R, Newman J, Bauman M. An evaluation of the advanced illness management (AIM) program: increasing hospice utilization in the San Francisco Bay area. J Palliat Med. 2006;9(6):1401-1411.
• Hughes MT, Smith TJ. The growth of palliative care in the United States. Annu Rev Public Health. 2014;35(1):459-475.
• Labson MC, Sacco MM, Weissman DE, Gornet B, Stuart B. Innovative models of home-based palliative care. Cleve Clin J Med. 2013;80(E-Supplement 1):30-35.
• Maida V, Ennis M, Kuziemsky C, Corban J. Wounds and survival in cancer patients. Eur J Cancer. 2009;45(18):3237-3244.
• Artico M, Dante A, D’Angelo D, et al. Prevalence, incidence and associated factors of pressure ulcers in home palliative care patients: a retrospective chart review. Palliat Med. 2018;32(1):299-307.
• Brian Cassel J, Kerr KM, McClish DK, et al. Effect of a home-based palliative care program on healthcare use and costs. J Am Geriatr Soc. 2016;64(11):2288-2295.
• Bosel J, Schiller P, Hook Y, et al. Stroke-related early tracheostomy versus prolonged orotracheal intubation in neurocritical care trial (SETPOINT): a randomized pilot trial. Stroke. 2013;44(1):21-28.
• Spataro R, Bono V, Marchese S, La Bella V. Tracheostomy mechanical ventilation in patients with amyotrophic lateral sclerosis: clinical features and survival analysis. J Neurol Sci. 2012;323(1-2):66-70.
• Pan CX, Gutierrez C, Maw MM, et al. Impact of a palliative care program on tracheostomy utilization in a community hospital. J Palliat Med. 2015;18(12):1070-1073.
• Glover TL, Kluger BM. Palliative medicine and end-of-life care. Handb Clin Neurol. 2019;167:545-561.
• Robinson MT, Holloway RG. Palliative care in neurology. Mayo Clin Proc. 2017;92(10):1592-1601.
• Taylor BL, O’Riordan DL, Pantilat SZ, Creutzfeldt CJ. Inpatients with neurologic disease referred for palliative care consultation. Neurol. 2019;92(17):e1975-e1981.
• Newman III AJ, Kvale EA, Williams BR, Bailey FA. What about the trach? Tracheotomy removal as a palliative care maneuver. Am J Hosp Palliat Care. 2007;24(5):371-375.
• Chan T, Devaiah AK. Tracheostomy in palliative care. Otolaryngol Clin North Am. 2009;42(1):133-141.
• Sherlock ZV, Wilson JA, Exley C. Tracheostomy in the acute setting: patient experience and information needs. J Crit Care. 2009;24(4):501-507.
• Cameron JI, Chu LM, Matte A, et al. One-year outcomes in caregivers of critically ill patients. N Engl J Med. 2016;374(19):1831-1841.
• Nakarada-Kordic I, Patterson N, Wrapson J, Reay SD. A Systematic review of patient and caregiver experiences with a tracheostomy. Patient. 2018;11(2):175-191.
• Nagi M, Kapoor S, Kaur S, Gupta S. Effect of an intervention on performance regarding change of tracheostomy tube among the caregivers of the patient. Indian J Neurosurg. 2014;3(1):31-35.
• World Health Organization. Strengthening of palliative care as a component of integrated treatment throughout the life course. J Pain Palliat Care Pharmacother. 2014;28(2):130-134.
• Langemo DK, Black J. Pressure ulcers in individuals receiving palliative care: a National Pressure Ulcer Advisory Panel white paper. Adv Skin Wound Care. 2010;23(2):59-72.
• Lyder CH, Wang Y, Metersky M, et al. Hospital-acquired pressure ulcers: results from the national Medicare Patient Safety Monitoring System study. J Am Geriatr Soc. 2012;60(9):1603-1608.
• Allman RM. The impact of pressure ulcers on health care costs and mortality. Adv Wound Care. 1998;11:2.
• Hudson P. Improving support for family carers: key implications for research, policy and practice. Palliat Med. 2013;27(7):581-582.
• Chellappan S, Ezhilarasu P, Gnanadurai A, George R, Christopher S. Can symptom relief be provided in the home to palliative care cancer patients by the primary caregivers? An Indian study. Cancer Nurs. 2014;37(5):E40-E47.