Identification of Patients Admitted in an Internal Medicine Ward with Palliative Care Needs
DOI:
https://doi.org/10.24950/O/265/19/2/2020Keywords:
Internal Medicine, Palliative Care, Surveys and QuestionnairesAbstract
Introduction: Palliative Medicine is a growing area in Portugal, but until now the existence of such care has not been done in a structured way. The ageing population and the increasing in chronic diseases prevalence in advanced stage, progressive and debilitating diseases, provides increasingly demand of health care services and hospitalization, implying increased spending if such patients are not identified as palliative. The present study aims to assess the need for Palliative Care (PC) in patients hospitalized in an internal medicine department.
Methodology: A retrospective and observational study is presented, including patients aged ≥ 60 years, for a period of three months. It was applied the Palliative Care Screening Tool scale (PCST) in order to identify the potential candidates for Palliate Care (score ≥ 4).
Results: Three hundred and twenty-eight patients were admitted, but only 288 (88%) were evaluated and 54% of them presented score ≥ 4 points at PCST scale, eligible for PC. In this group, the average age was 82 years; 54% women and 46% men. Admission median was 11 days. The main co- morbidities were dementia in 47%, stroke in 45% and chronic kidney disease in 39%. The appreciation of psychological problems was not recognized. The mortality rate was 31% and only one patient was admitted in PC unit.
Conclusion: This study testifies that PC patients are hos- pitalized in Internal Medicine Services, and it also shows the importance of specific training of internists as well as research in this particular area and the use of specific scales with the potential to identify these patients.
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Carneiro R, Sousa E, Guerreiro T, Rocha N. Qualidade e Satisfação com a Prestação de Cuidados na Patologia Avançada em Medicina Interna. Arq Med. 2009; 23: 95-101.
Campos L. A Medicina Interna e o futuro dos Cuidados de Saúde. Rev Soc Port Med Interna. 2015; 22: 10-5.
Moura BP. O impacto da Rede Nacional de Cuidados Continuados Integra- dos (RNCCI) na demora média hospitalar. [Dissertação de Mestrado Universidade Nova de Lisboa]. Lisboa: Universidade Nova de Lisboa; 2014. [consultado Out 2019] Disponível em: http://hdl.handle.net/10362/14626
Pulido I, Baptista I, Brito M, Matias T. Como Morrem os Doentes numa Enfermaria de Medicina Interna. Rev Soc Port Med Int. 2010: 17: 222-6.
Macedo P. Governo quer soluções mais eficazes para casos de idosos “depositados” nos hospitais. 2015. consultado Out 2019] Disponível em: http://www.ionline.pt/272893
Gonçalves J.F. A Boa Morte: ética no fim da vida. Lisboa: Coisas de Ler Edições; 2009.
Direcção Geral da Sáude. Programa Nacional de Cuidados Paliativos. Lisboa: DGS; 2004.
Lobão MJ. Editorial. Osler, Medicina Interna e Cuidados Paliativos. Rev Soc Port Med Int. 2013; 20: 3-4.
Murray SA, Boyd K, Sheikh A. Palliativecare in chronicillness. BMJ. 2005; 330:611-2.
Kellett J. Prognostication - The lost skill of medicine. Eur J Intern Med. 2008; 19: 155-64.
Carneiro R, Freire E, Alves, Rocha N. Gestos e atitudes em medicina centrada no doente num Serviço de Medicina Interna. Acta Med Port 2010; 23: 1035-42.
Navarro Sanz R, López Almazán C. Aproximación a los Cuidados Paliativos en las enfermedades avanzadas no malignas. An Med Interna. 2008;25.
Murray SA, Sheikh A. Palliative care beyond cancer: care for all at the end of life. BMJ. 2008; 336: 958-9.
Silva MJ. Cuidados paliativos: caracterização assistencial e identificação de necessidades num serviço de medicina interna. [Dissertação de Mestrado, Faculdade de Medicina da Universidade de Lisboa]. Lisboa: Faculdade de Medicina da Universidade de Lisboa; 2011.
Ribeiro AS. Controlo de sintomas em cuidados paliativos num serviço de medicina interna.[Dissertação de Mestrado, Faculdade de Medicina da Universidade de Lisboa]. Lisboa: Faculdade de Medicina da Universidade de Lisboa; 2012.
Lynn J, Teno JM, Phillips RS, Wu AW, Desbiens N, Harrold J,et al. Perceptions by Family Members of the Dying Experience of Older and Serionsly ill Patients. SUPPORT Investigators. Ann Intern Med. 1997; 126: 97-106.
Toscani F, Di Giulio P, Brunelli C, Miccinesi G, Laquintana D; End-of-Life Observatory Group. How people die in hospital general wards: a descriptive study. J Pain Symptom Manage. 2005;30:33-40.
Babarro AA, Aguilar AG, Rexach CN. Cuidados paliativos enenfermedades no oncológicas. Med Pal. 2010; 17:156-60.
Fischer SM, Gozansky WS, Sauaia A, Min SJ, Kutner JS, Kramer A. A practical tool to identify patients who may benefit from a palliative approach: the CARING criteria. J Pain Symptom Manage.2006;31:285-92.
Stern R. A need for a palliative care program among hospitalized patients in the departments of internal medicine. Arch Intern Med 2006; 166: 149-50.
Monteiro P, Silva M J, Fraga M, Mota C, Suarez A, Ponte C. et al. Neces- sidade de Cuidados Paliativos num Serviço de Medicina Interna. Rev Soc PortMed Int. 2013 ; 20: 7-20.
Lucchetti G, Neto A, Ramos S, Faria L, Granero A, Pires S, Gorzoni M. Uso de uma escala de triagem para cuidados paliativos nos idosos de uma instituição de longa permanência. Geriatria Gerontol. 2009 ;3: 104-8
Applegate WB, Blass JP, Williams TF. Instruments for the functional assessment of older patients. N Engl J Med. 1990;322:1207-14.
Alonso Barbarro A, Gonzalez Baron M. Medidas de capacidad funcional. In: Gonzalez Baron M, Lacasta M, Ordonez A. Valoración clínica en el paciente con cáncer. Madrid: Editorial Médica Panamericana. 2006. p.1-16.
Maas EA, Murray SA, Engels Y, Campbell C. What tools are available to identify patients with palliative care needs in primary care: a systematic lite- rature review and survey of European practice. BMJ Support Palliat Care. 2013;3:444-51. doi: 10.1136/bmjspcare-2013-000527.
Highet G, Crawford D, Murray SA, Boyd K.Development and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT):a mixed-methods study. BMJ Support Palliat Care. 2014;4:285-90. doi:10.1136/bmjspcare-2013-000488.
Sigurdardottir K, Haugen D. Prevalence of distressing symptoms in hospitalased patients on medical wards: a cross sectional study. BMC Palliat Care. 2008; 23:7-16.
Gott CM, Ahmedzal SH,Wood C . How many inpatients in an acute hospital have palliative care needs? Comparing the perspectives of medical and nursing staff. Palliat Med. 2001; 15: 451-60.
Costa MA, Antunes MT. Avaliação de sintomas em doentes sem perspetiva de cura. Rev. Enf Ref. 2012;3: 63-72.
Loureiro N, Amado J, Fragoso R. Cuidados paliativos: Identificação de necessidades em doentes de medicina interna. Rev Cuidados Paliat. 2014: 1; 62-73.
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