SENTINEL PRACTICES IN EVALUATING LONGER PERIODS OF CARE - QUALITY-OF-LIFE AND DRUG-THERAPY OF TERMINALLY ILL PERSONS IN LOWER SAXONY (GERMANY)

Study objectives-(1) To study the feasibility of using sentinel practi ce networks to evaluate longer periods of care. (2) To assess the qual ity of life and drug therapy of community dwelling terminally ill pers ons. Design-Prospective longitudinal design with GPs in an existing se ntinel practice network identifying ''terminally ill'' persons and rec ording the following data: age, sex, diagnoses, and ongoing drug thera py initially, time, place, duration, services, and drug changes for ev ery contact, quality of life (HRCA-QL Index, Spitzer Index, uniscale), pain intensity and frequency on a weekly basis, and time and circumst ances of death. Setting-26 GP practices in Lower Saxony, Germany. Pati ents-47 patients (age: mean 76 years, range 31 to 98; sex: 21 male, 26 female; diagnosis: 35 with cancer) with 582 contacts. Mean of recorde d time before death was 70 days (median 50). Main results-Average numb er of physician-patient contacts increased from 0.7 a week three month s before death to 2.4 in the final week. Quality of life decreased dur ing that period (HRCA-QL Index: 5.1 to 0.8; Spitzer: 4.4 to 0.8; unisc ale: 37 to 9). In the last week of life, no person was free of pain; a nalgetic therapy was ((successful)) in 57% of cases. Conclusions-(1) T he sentinel practice approach is feasible for evaluating longer period s of care. The generalisibility, however, may be limited to certain su bgroups. (2) The observed trends in quality of life, pain, and analget ic treatment should be compared with those in other settings and count ries to identify the scope of care improvement.