In recent times, German legislation has given terminally ill patients the right to receive SAPV, a multi-professional palliative care model which is aimed at prevention of hospital admission and enabling patients to die at home despite severe symptoms and a high need for palliative care. This new type of care raises the question about the best implementation and impact of SAPV. HC provides SAPV to 560.000 inhabitants of the city of Mönchengladbach and the district of Viersen.
Data collected during daily care from 2012 to 2016 are summarized and analysed in order to describe the implementation and results of SAPV.
1798 patients were treated in 5 years. The first contact with SAPV was initiated by a GP in 30% of patients and by a specialist in 4.5%; in 26% through a hospital, in 6% by a palliative care unit and in at least 30% by non-medical participants, such as relatives, nursing services, counseling centers etc. 20% of all patients were treated only temporarily by SAPV. 6% were admitted to a hospice, 14% were transferred to regular care after counseling or crisis intervention. Of the remaining patients, only 3.3% had to be hospitalized at the end and 96.7% were able to remain in their chosen home environment. That was at home for 80%, at a relative’s home for 3%, in a nursing home for 14%, and miscellaneous for the remaining 3% of patients. Sonography, thoracic and abdominal paracentesis, patient-controlled analgesia etc. were performed in the patient's home by the SAPV team. Of all 1798 patients, 112 had to be hospitalized; 64 were subsequently retreated with SAPV and 48 were not. The main reasons for hospitalization were palliative interventions due to ileus and urinary retention in the upper tract, radiation of a fracture, psychosocial decompensation of the supporting relatives and confirmation of the palliative concept. The average treatment duration was 19 days, the median was under 10 days. In detail, 112 patients were treated for less than 24 hours, 271 patients for less than 48 hours, 57 patients were treated for more than 90 days and 4 patients for over 200 days.
The wish of patients to die at home and to avoid unnecessary hospitalization can be achieved with this model of specialized care. Further comparative investigations are necessary to identify the optimal implementation and impact of SAPV.
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All authors have declared no conflicts of interest.