介護施設での緩和ケアとホスピスへのアクセス
J Zerzan1, S Stearns, L Hanson
1Division of General Medicine, CB 7110, 5035 Old Clinic Bldg, University of North Carolina, Chapel Hill, NC 27599-7110, USA.
JAMA
|November 14, 2000
まとめ
多くの高齢者が介護施設で亡くなるが,緩和ケアやホスピスサービスへのアクセスは限られている. これらの居住者の終末期ケアを改善するために,政策の変更が必要である.
科学分野:
- ゲロントロジーはゲロントロジーの学科です.
- 緩和ケアとは,緩和ケアです.
- 健康政策 保健政策 保健政策
背景:
- 介護施設は,慢性疾患を持つ高齢者の死亡の場となっている.
- 死にかけている住民は,しばしば治療されていない痛みと社会的孤立を経験します.
- これらの住民の緩和ケアやホスピスケアへのアクセスは,著しく制限されています.
研究 の 目的:
- 介護施設におけるホスピス介護の活用を調査する.
- 死にかけている老人ホームの住人のホスピスと緩和ケアへのアクセスを妨げる障害を特定する.
- 介護施設における終末期介護を改善するための政策変更を提案する.
主な方法:
- 介護施設での死亡の傾向の分析.
- ホスピスの入院データを見直す.
- 健康政策,品質基準,払い戻しのルールの検討.
主要な成果:
- 介護施設で発生する死亡の割合は,1986年から1993年まで増加した.
- ホスピス介護は,終末期介護を大幅に改善しますが,介護施設では十分に活用されていません (1997年に入学者のわずか13%).
- 多くの介護施設にはホスピス患者がいなかったため,地域や管理者の態度によって使用が異なっていた.
結論:
- 現在の保健政策と補償構造は,老人ホームでの緩和ケアやホスピスケアへの阻害要因となっている.
- 障壁には,復元ケアを好む品質基準と払い戻しのルールが含まれます.
- 政策,品質基準,払い戻しインセンティブの改革は,老人ホームの住人の死に際し,緩和ケアやホスピスケアへのアクセスを改善するために不可欠です.
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