masterThesis
Factores asociados a mortalidad a 6 meses en pacientes en cuidados paliativos domiciliarios en Bogotá
Autor
Plazas Sánchez, Diego Kestutti
Duque Arango, Catalina
Piñeros Sanabria, Ana María
Institución
Resumen
Introduction: The clear aging of the global population and the incidence of non-communicable illness implies a transformation in the demand for health services, specifically in palliative care. There are departments in Colombia that don’t have palliative care services, as the majority are concentrated in the country’s central zone. In a low complexity Palliative Home Care Program (PHCP) in Bogotá, a lack of precision has been found in the estimation of survival, wasting part of the resources. Objective: To identify the sociodemographic and clinical factors associated with 6-month mortality in patients admitted to the low-complexity PHCP in Bogotá from January 1, 2018 to June 30, 2019. Method: Analytical retrospective observational cohort study, the survival function was measured by calculating the Kaplan Meier estimator and curve with 95% confidence interval. COX Proportional Hazards Model was used for the correlation between explanatory variables (sociodemographic and clinical) and the rate of the study event (death within 6 months of admission) through obtaining the Hazard Ratio (HR) as the measure of association. Results: The final model, with a concordance of 0.678 and a global p proportionality test of 0.08, includes: previous diagnosis of oncological disease (HR = 2.23, 95% CI: 1.47-3.37), hyporexia / anorexia (HR = 1.60, 95% CI: 1.07-2.39), implanted subcutaneous catheter (SC) (HR = 2.21, 95% CI: 1.21-4.03), dysphagia (HR = 1.92, 95% CI: 1.27-2.91) and pressure ulcers (HR = 1.56, 95% CI: 1.002-2.45). Sociodemographic variables were not entered into this model. Conclusions: The evaluation of the sociodemographic and clinical features associated with mortality in palliative care continues to be an invaluable tool that improves the quality of health care, quality end of life care and administration of resources. An oncological diagnosis, loss of appetite or loss of the oral intake, dysphagia, subcutaneous catheter and pressure ulcers, especially in stages 3 and 4, are clinical factors that may be associated with 6-month mortality in Palliative Home Care Programs. Their identification will allow interdisciplinary teams to anticipate difficulties and needs faced by patients in palliative care and their families.