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Dr. Peter Tanuseputro treats most of his dying patients in their own homes. He offers patients his cellphone number and the assurance that he will be there when they need him.
These house calls — part palliative care, part hand-holding — are embraced by grateful patients and their families. And they make the Orléans family medicine practice that Tanuseputro shares with his wife stand out.
“We are in the minority,” he says of their home visits.
What the husband and wife physicians do is relatively rare in Ontario, where most people say they want to die in their own homes, but few do. Nearly 70 per cent of Ontario residents die in hospitals or long-term care facilities — some of them in busy emergency rooms waiting for a bed. Lack of access to in-home end-of-life care is key to the discrepancy between wishes and reality when it comes to end of life.
Related
Tanuseputro, who is a researcher with the Bruyère Research Institute, is lead author of a new study that draws a direct link between the kind of house calls he routinely makes and the number of Ontario patients dying in hospital beds rather than in their homes.
The study, from the Institute for Clinical Evaluative Sciences (ICES) was published Thursday in the journal PLOS ONE. It is the largest of its kind to look at the impact of doctor home visits on where people die.
Using records of 264,755 Ontario patients who died between April 1, 2010 and March 31, 2013, Tanuseputro and a team of researchers found that end-of-life care, including house calls and in-home palliative care could reduce a patient’s chance of dying in hospital by about 50 per cent.
Despite that, the researchers found that fewer than 20 per cent of Ontario residents received a house call from their doctor or in-home palliative care in the last year of their lives.
That is something the Ontario government has vowed to change by improving access to palliative care for people in the community.
The Champlain LHIN, which includes Ottawa, does better than many parts of the province when it comes to helping people who want to remain in their homes to die. About 45 per cent of people, according to Tanuseputro’s research, die in hospital (a figure that excludes deaths in nursing homes), the lowest region in the province. A regional palliative care team aims to improve access to palliative care at home in the region. Local health integration networks across the province are monitoring progress.
But Tanuseputro’s research suggests home visits do not need to be from specialty palliative care teams in order to help patients remain in their own homes. House calls by family physicians or nurse practitioners — who can prescribe medication, educate the family on how to administer the medicine and what to expect — can help patients who wish to remain at home to die to do so.
“A good death contributes to a good life lived,” writes Tanuseputro and his team in the research paper. “We have shown that receiving a physician home visit near the end of life is strongly associated with an out-of-hospital death, aligned with the wishes of most.”
The researchers note that not all deaths can or should occur outside of hospital, but more should.
Moving deaths out of acute care hospital beds has obvious benefits for the health system — especially at a time when overcrowding is forcing some hospitals to treat patients in hallways and other non-traditional spaces.
A 2014 auditor general’s report suggested allowing people to die at home when they are able, and prefer to, would save the province $600 per day of care.
The benefits to patients are less easy to measure but profound.
Michelle Pelkey, whose husband Rick died from pancreatic cancer while under Tanuseputro’s care in 2015, said they were amazed when the family physician told them he would begin coming to their home weekly, about five weeks before Rick’s death, and gave them his phone number.
Michelle Pelkey poses for a photo in Ottawa Thursday Feb 15, 2018. Michelle Pelkey’s husband received house calls from his doctor before his 2015 death.
“We never expected that. It was a reassurance,” she said, adding: “He told me to call him whenever I needed him. I couldn’t believe that a doctor would give me his personal cellphone number.”
During one of his visits, Pelkey said, Tanuseputro sat beside her husband’s bed and asked him how he felt. She said she was surprised by the question, it was something she wouldn’t have asked her dying husband, in part because she feared the answer. But she was amazed by what he said.
“I am at peace,” her husband told the doctor.
It is something that gave Pelkey comfort and she would never have known if Tanuseputro hadn’t asked.
“Dr. Peter said to me that if you can describe a death as being a beautiful death, that is what Rick experienced.”
epayne@postmedia.com
查看原文...
These house calls — part palliative care, part hand-holding — are embraced by grateful patients and their families. And they make the Orléans family medicine practice that Tanuseputro shares with his wife stand out.
“We are in the minority,” he says of their home visits.
What the husband and wife physicians do is relatively rare in Ontario, where most people say they want to die in their own homes, but few do. Nearly 70 per cent of Ontario residents die in hospitals or long-term care facilities — some of them in busy emergency rooms waiting for a bed. Lack of access to in-home end-of-life care is key to the discrepancy between wishes and reality when it comes to end of life.
Related
Tanuseputro, who is a researcher with the Bruyère Research Institute, is lead author of a new study that draws a direct link between the kind of house calls he routinely makes and the number of Ontario patients dying in hospital beds rather than in their homes.
The study, from the Institute for Clinical Evaluative Sciences (ICES) was published Thursday in the journal PLOS ONE. It is the largest of its kind to look at the impact of doctor home visits on where people die.
Using records of 264,755 Ontario patients who died between April 1, 2010 and March 31, 2013, Tanuseputro and a team of researchers found that end-of-life care, including house calls and in-home palliative care could reduce a patient’s chance of dying in hospital by about 50 per cent.
Despite that, the researchers found that fewer than 20 per cent of Ontario residents received a house call from their doctor or in-home palliative care in the last year of their lives.
That is something the Ontario government has vowed to change by improving access to palliative care for people in the community.
The Champlain LHIN, which includes Ottawa, does better than many parts of the province when it comes to helping people who want to remain in their homes to die. About 45 per cent of people, according to Tanuseputro’s research, die in hospital (a figure that excludes deaths in nursing homes), the lowest region in the province. A regional palliative care team aims to improve access to palliative care at home in the region. Local health integration networks across the province are monitoring progress.
But Tanuseputro’s research suggests home visits do not need to be from specialty palliative care teams in order to help patients remain in their own homes. House calls by family physicians or nurse practitioners — who can prescribe medication, educate the family on how to administer the medicine and what to expect — can help patients who wish to remain at home to die to do so.
“A good death contributes to a good life lived,” writes Tanuseputro and his team in the research paper. “We have shown that receiving a physician home visit near the end of life is strongly associated with an out-of-hospital death, aligned with the wishes of most.”
The researchers note that not all deaths can or should occur outside of hospital, but more should.
Moving deaths out of acute care hospital beds has obvious benefits for the health system — especially at a time when overcrowding is forcing some hospitals to treat patients in hallways and other non-traditional spaces.
A 2014 auditor general’s report suggested allowing people to die at home when they are able, and prefer to, would save the province $600 per day of care.
The benefits to patients are less easy to measure but profound.
Michelle Pelkey, whose husband Rick died from pancreatic cancer while under Tanuseputro’s care in 2015, said they were amazed when the family physician told them he would begin coming to their home weekly, about five weeks before Rick’s death, and gave them his phone number.
Michelle Pelkey poses for a photo in Ottawa Thursday Feb 15, 2018. Michelle Pelkey’s husband received house calls from his doctor before his 2015 death.
“We never expected that. It was a reassurance,” she said, adding: “He told me to call him whenever I needed him. I couldn’t believe that a doctor would give me his personal cellphone number.”
During one of his visits, Pelkey said, Tanuseputro sat beside her husband’s bed and asked him how he felt. She said she was surprised by the question, it was something she wouldn’t have asked her dying husband, in part because she feared the answer. But she was amazed by what he said.
“I am at peace,” her husband told the doctor.
It is something that gave Pelkey comfort and she would never have known if Tanuseputro hadn’t asked.
“Dr. Peter said to me that if you can describe a death as being a beautiful death, that is what Rick experienced.”
epayne@postmedia.com
查看原文...
