Genel uygulamada demans, kanser ve diğer kronik ilerlemeli hastalıklar için ileri bakım planlamasının gerçekleşmesi: idari verilerle bağlantılı sağlık kayıtlarından elde edilen verilerin uzunlamasına analizi.

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ObjectivesThere are substantial barriers to initiate advance care planning (ACP) for persons with chronic-progressive disease in primary care settings. Some challenges may be disease-specific, such as communicating in case of cognitive impairment. This study assessed and compared the initiation of ACP in primary care with persons with dementia, Parkinson's disease, cancer, organ failure and stroke.DesignLongitudinal study linking data from a database of Dutch general practices' electronic health records with national administrative databases managed by Statistics Netherlands.Setting and participantsData from general practice records of 199 034 community-dwelling persons with chronic-progressive disease diagnosed between 2008 and 2016.Outcome measureIncidence rate ratio (IRR) of recorded ACP planning conversations per 1000 person-years in persons with a diagnosis of dementia, Parkinson's disease, organ failure, cancer or stroke, compared with persons without the particular diagnosis. Poisson regression and competing risk analysis were performed, adjusted for age, gender, migration background, living situation, frailty index and income, also for disease subsamples.ResultsIn adjusted analyses, the rate of first ACP conversation for persons with organ failure was the lowest (IRR 0.70 (95% CI 0.68 to 0.73)). Persons with cancer had the highest rate (IRR 1.75 (95% CI 1.68 to 1.83)). Within the subsample of persons with organ failure, the subsample of persons with dementia and the subsample of stroke, a comorbid diagnosis of cancer increased the probability of ACP. Further, for those with organ failure or cancer, comorbid dementia decreased the probability of ACP.ConclusionsConsidering the complexity of initiating ACP for persons with organ failure or dementia, general practitioners should prioritise offering it to them and their family caregivers. Policy initiatives should stimulate the implementation of ACP for people with chronic-progressive disease.

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