Date : 2018
Type : Livre / Book
Type : Thèse / ThesisLangue / Language : français / French
Accès en ligne / online access
Résumé / Abstract : INTRODUCTION : L’HAD est l’un des acteurs principaux dans le champ de la prise en charge de patients en fin de vie. Avec plus du quart de son activité consacré aux soins palliatifs, l’HAD est une ressource potentielle pour le domicile, pour les établissements médico-sociaux et sociaux dans le cadre d’un accompagnement de personnes en fin de vie. METHODES : une étude descriptive rétrospective monocentrique a été effectuée, les dossiers de 130 patients décédés en HAD sur l’année 2016, déclarés en soins palliatifs, ont été analysé. RESULTATS : de la totalité des patients décédés en HAD en 2016, 96,3% ont été déclarés en soins palliatifs. La moyenne d’âge est de 78,9 ans, les patients pris en charge pour une pathologie cancéreuse sont plus jeunes avec une moyenne d’âge à 75 ans et les patients décédés dans un contexte de polypathologie sont plus âgé, la moyenne d’âge étant de 89 ans. 23% des séjours sont des séjours très court (
Résumé / Abstract : Introduction : home care plays a pivotal role in patients that are in an end-of-life stage. Indeed, home care is an important asset to hospitals and other health institutions as well as for families, especially in a palliative setting. Lastly, palliative care represents more than a quarter of total home care services. Methods : in this retrospective observational study, we analyzed all 130 patients’ files who were on home palliative care and who died during 2016. Results : the clear majority (96.3 %) of home care patients who had passed away in 2016 were on palliative care. Mean age was 78.9 years in total population with a mean of 75 years in the cancer sub-group population versus a higher mean of 89 years in the polypathology population. Twenty-three percent of hospital stay was less than 4 days, mainly due to doctors’ inability to foresee prescriptions. Indeed, most of home care prescriptions were written in the hospital and only 32 % were prescribed by general practitioners. Home care in establishments providing care for the dependent elderly was 23.8 %. Palliative care concerned mainly the oncology population (73 %), followed by chronic respiratory failure population. Palliative care specialists prescribed treatment in 50 % of cases and GP’s in 27.7 % of cases. Opioid painkillers were present in 66.9 % of cases at admission and consisted mainly of transdermal fentanyl patches whereas, in terminal stage, they had increased to 86.9 % and consisted of morphine. Likewise, benzodiazepines (mainly Midazolam) were prescribed in 50 % of patients at admission and increased to 73 % in final stage. Other medical treatments used in terminal stage were Scopolamine by transdermal delivery and Amitriptyline by IV delivery. Conclusion : home care medical treatment in an end-of-life situation follows guidelines, is closely coordinated by a palliative-care specialist, and consists mainly of alleviating pain, anxiety, lung congestion and dyspnea.