Nurse practitioner and physician end-of-life home visits and end-of-life outcomes.

Autor:	Scott MM; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada marscott@ohri.ca ahsu@bruyere.org., Ramzy A; Bruyère Research Institute, Ottawa, Ontario, Canada., Isenberg SR; Bruyère Research Institute, Ottawa, Ontario, Canada.; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada., Webber C; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada., Eddeen AB; ICES uOttawa, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada., Murmann M; Bruyère Research Institute, Ottawa, Ontario, Canada., Mahdavi R; ICES uOttawa, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada., Howard M; Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada., Kendall CE; Bruyère Research Institute, Ottawa, Ontario, Canada.; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada., Klinger C; Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada., Marshall D; Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada., Sinnarajah A; Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston, Ontario, Canada.; Lakeridge Health, Oshawa, Ontario, Canada., Ponka D; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada., Buchman S; Division of Palliative Care, Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada., Bennett C; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada., Tanuseputro P; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.; Bruyère Research Institute, Ottawa, Ontario, Canada.; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.; ICES uOttawa, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada., Dahrouge S; Bruyère Research Institute, Ottawa, Ontario, Canada.; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada., May K; Emergency Department, Ottawa Hospital, Ottawa, Ontario, Canada., Heer C; Bruyère Research Institute, Ottawa, Ontario, Canada.; Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada., Cooper D; Nurse Practitioners' Association, Toronto, Ontario, Canada., Manuel D; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.; Bruyère Research Institute, Ottawa, Ontario, Canada.; ICES uOttawa, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada., Thavorn K; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.; ICES uOttawa, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada., Hsu AT; Bruyère Research Institute, Ottawa, Ontario, Canada marscott@ohri.ca ahsu@bruyere.org.; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	BMJ supportive & palliative care [BMJ Support Palliat Care] 2023 Nov 18. Date of Electronic Publication: 2023 Nov 18.
DOI:	10.1136/spcare-2023-004392
Abstrakt:	Objectives: Physicians and nurse practitioners (NPs) play critical roles in supporting palliative and end-of-life care in the community. We examined healthcare outcomes among patients who received home visits from physicians and NPs in the 90 days before death. Methods: We conducted a retrospective cohort study using linked data of adult home care users in Ontario, Canada, who died between 1 January 2018 and 31 December 2019. Healthcare outcomes included medications for pain and symptom management, emergency department (ED) visits, hospitalisations and a community-based death. We compared the characteristics of and outcomes in decedents who received a home visit from an NP, physician and both to those who did not receive a home visit. Results: Half (56.9%) of adult decedents in Ontario did not receive a home visit from a provider in the last 90 days of life; 34.5% received at least one visit from a physician, 3.8% from an NP and 4.9% from both. Compared with those without any visits, having at least one home visit reduced the odds of hospitalisation and ED visits, and increased the odds of receiving medications for pain and symptom management and achieving a community-based death. Observed effects were larger in patients who received at least one visit from both. Conclusions: Beyond home care, receiving home visits from primary care providers near the end of life may be associated with better outcomes that are aligned with patients' preferences-emphasising the importance of NPs and physicians' role in supporting people near the end of life. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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