End-of-life care in Germany Study design, methods and first results of the EPACS study (Establishment of Hospice and Palliative Care Services in Germany).docVIP

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End-of-life care in Germany Study design, methods and first results of the EPACS study (Establishment of Hospice and Palliative Care Services in Germany).doc

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End-of-life care in Germany Study design, methods and first results of the EPACS study (Establishment of Hospice and Palliative Care Services in Germany)

EscobarPinzónetal.BMCPalliativeCare2010,9:16 /1472-684X/9/16 RESEARCH ARTICLE OpenAccess End-of-lifecareinGermany:Studydesign, methodsandfirstresultsoftheEPACSstudy (EstablishmentofHospiceandPalliativeCare ServicesinGermany) LuisCarlosEscobarPinzón1*,EvaMünster1,SabineFischbeck2,MichaelUnrath1,MatthiasClaus1,TanjaMartini1, MartinWeber3 Abstract Background:Inordertotacklethedeficitsintheprovisionofpalliativehomecare,profoundstructuralchangesin theoutpatientsectorwereintroducedbylawinGermanyin2007.TheEPACSstudywascarriedout(Research AccompanyingtheEstablishmentofHospiceandPalliativeCareServicesinRhineland-Palatinate,Germany)to documentthequalityofinpatientandoutpatientend-of-lifecareinRhineland-Palatinate,Germany,beforethe implementationofthesechanges.WiththisarticlewefocusonthestudydesignandmethodsoftheEPACS-Study. Wefurtherreportfirstresultsregardingseveralaspectsofoutpatientend-of-lifecare. Methods:Thecross-sectionalsurveywasbasedonarandomsampleof5000inhabitantsofRhineland-Palatinate thathaddiedfromMay25untilAugust24oftheyear2008.Relativesoftheserandomlydrawndeceasedpersons wereinterviewedbymeansofawrittensurvey. Results:Theoverallresponseproportionconsideringonlythosequestionnairesthatactuallyweredelivered(n= 3833)was36.0%.Factorsinfluencingparticipationwereage,sex,andmaritalstatus.355(25.8%)deceasedpersons hadusedprofessionalhomecareinthefourweekspriortotheirdeath,butonlyveryfewpersonshaduseda specialisedpalliativehomecareservice(n=30;8.5%).Therewasacleargapbetweentheneedforspecialised outpatientcareandtheactualutilisationoftheseservices. Conclusions:Satisfactionwithprofessionalhomecarewasrelativelyhigh,butphysicianswereratedless favourablethannurses.Thereweredeficitsespeciallywithrespecttophysicians’communicativeandsupportive skills.Furtheranalysesarenecessarytoprovidemoredetailedinformationaboutqualityofcareindifferentcare settingsandfordistinctgroups.Predictorsofgoodcare,aswellasobstaclestoit,mustbefurtherinvestigated.In thelongrun,afollow-upsurveymustbecon