【公告】有關「健保給付末期衰弱老人安寧緩和醫療」補充說明
最新日期:2022-08-08
有關「健保給付末期衰弱老人安寧緩和醫療」補充說明
末期衰弱老人納入健保安寧緩和醫療給付之適應症符合國際趨勢
本學會欣見健保署採納本學會近年來的倡議,自2022年6月起將末期衰弱老人納入安寧緩和醫療給付的適應症,符合國際安寧緩和醫療去疾病化的發展趨勢,將進一步提升高齡社會老人的末期照護品質。
以CFS評估衰弱老人進展到嚴重或末期階段並以SPICT評估其安寧緩和醫療需求
衰弱是老人一種易受傷害狀態,容易因為無法因應身體或環境變化,有較高風險進展至功能依賴、生活品質不佳或死亡。
衰弱老人經臨床衰弱量表(Clinical Frailty Scale,CFS)評估衰弱已進展到極嚴重衰弱(第八級)及末期病況(第九級),可以判斷預後不佳,預期存活時間短,也就是近期內病程進行至死亡已不可避免的末期衰弱個案。建議進一步以SPICT(Supportive and Palliative Care Indicators Tool)評估提供適切的安寧緩和醫療。如果符合SPICT第一階段一般性指標,且符合SPICT第二階段針對「衰弱 / 失智」的指標,代表預後不佳,且可能有未被滿足的安寧緩和醫療照護需求。可以在既有的醫療照護中合併有安寧緩和醫療照護內涵,或可能需要轉介安寧緩和醫療團隊,提供適切的安寧緩和醫療。
周全評估衰弱老人的安寧緩和醫療急慢性適應症並以健保收案照護
依健保末期衰弱老人安寧緩和醫療收案條件,需要符合「衰弱老人」、「末期階段」及「合併不適之症狀」,建議評估及記錄內容應該涵蓋這些項目。更重要的是末期衰弱老人安寧緩和醫療照護應包涵身體、心理、社會及靈性的整體評估與照護,也就是疾病診斷應涵蓋「衰弱(R54)」、「慢性疾病」及「急性病症」,臨床決策過程及醫療照護的內容要強調以病人為中心,也要符合倫理原則與法律規範。同時末期衰弱老人低功能且起伏的病程更需要跨專業、跨體系的周全性、連續性醫療照護。
【參考資料】
1. Dalhousie University, Geriatric Medicine Research, Clinical Frailty Scale (CFS) (2020), Retrieved
from https://www.dal.ca/sites/gmr/our-tools/clinical-frailty-scale.html
2. The University of Edinburgh, Supportive and Palliative Care Indicators Tool (SPICT™) (2019),
Retrieved from https://www.spict.org.uk/the-spict/
3. 中央健康保險署(2022),安寧住院、居家、共同照護現行給付方式,Retrieved from
https://www.nhi.gov.tw/Content_List.aspx?n=BC4B6B42238D5D7A&topn=5FE8C9FEAE863B46
4. 台灣安寧緩和醫學學會編著(2020)。衰弱老人安寧緩和醫療照護指引。國民健康署。Retrieved from
https://reurl.cc/p1lrGb
5. 國家衛生研究院(2017),支持性及緩和療護指標工具-2017台灣版(SPICT-TW™)
*本說明內容版權所有,請尊重智慧財產權,若需引用,須經本會授權同意,並註明出處及原作者*
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