PDF(Pubmed)
Abstract：
Harmful use of illicit drugs and/or alcohol is linked to life-limiting illness and complex health and social care needs, but people who use substances and have complex needs do not receive timely palliative care and fail to achieve quality standards for a good death. They and their families often require support from multiple health and social care services which are shown to be poorly integrated and fail to deliver interdisciplinary care. This study aimed to identify the existing barriers and facilitators within and between services in providing this population with a good death. Using a mixed methods approach of survey, focus groups and semi-structured interviews, we explored the perspectives of practitioner and management staff across a range of health and social disciplines and organisations in one combined authority in a large city in the north west of England. Our findings indicate that practitioners want to provide better care for this client group, but face structural, organisational and professional boundary barriers to delivering integrated and shared care. Differences in philosophy of care, piecemeal commissioning and funding of services, and regulatory frameworks for different services, lead to poor and inequitable access to health and social care services. Ways forward for improving care are suggested as bespoke hostel-based accommodation for palliative care for this client group, and specialist link workers who can transcend professional and organisational boundaries to support co-ordination of services and support. We conclude that it is no longer adequate to call for more training, better communication and improved joint working. Complex care at the end of life requires creative and cohesive systemic responses that enable multi-disciplinary practitioners to provide the care they wish to give and enables individuals using substances to get the respect and quality service they deserve.
摘要：
有害使用非法药物和/或酒精与限制生命的疾病以及复杂的健康和社会护理需求有关，但是使用物质并有复杂需求的人没有得到及时的姑息治疗，也没有达到良好死亡的质量标准。他们及其家人通常需要多种健康和社会护理服务的支持，这些服务被证明整合不良，无法提供跨学科护理。这项研究旨在确定服务内部和服务之间现有的障碍和促进者，为该人群提供良好的死亡机会。采用混合调查方法，焦点小组和半结构化访谈，我们在英格兰西北部一个大城市的一个联合机构中探索了一系列健康和社会学科和组织的从业者和管理人员的观点。我们的研究结果表明，从业者希望为这个客户群体提供更好的照顾，但是面对结构性的，提供综合和共享护理的组织和专业边界障碍。护理哲学的差异，零碎的委托和服务资金，以及不同服务的监管框架，导致获得保健和社会护理服务的机会贫乏和不公平。建议将改善护理的方法作为为该客户群体提供姑息治疗的定制宿舍住宿，和专家联系工人，他们可以超越专业和组织界限，以支持服务和支持的协调。我们得出的结论是，要求更多的培训已经不够了，更好的沟通和改善联合工作。生命结束时的复杂护理需要创造性和有凝聚力的系统性反应，使多学科从业者能够提供他们希望给予的护理，并使使用物质的个人获得应有的尊重和优质服务。
