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Oral Abstracts - ACP in Primary and Aged Care
Controlled follow-up survey of qualified advance directives two years after implementation of an ACP program
  1. J In Der Schmitten1,
  2. C Mellert1,
  3. K Wegscheider2 and
  4. G Marckmann3
  1. 1Dpt Of General Practice, University Hospital Of Düsseldorf
  2. 2Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf
  3. 3Institute for Ethics, History and Philosophy of Medicine, Ludwig-Maximilian-University of Munich


Background: Implemented in 02/2009, the German regional ACP program beizeiten begleiten® (‘be caring betimes’), based on Respecting Choices®, has demonstrated a moderate effect on the distribution of advance directives in the intervention region's nursing homes. In a follow-up study, we examined whether the effect was sustained and increasing over time.

Methods: Two years after the intervention (04/2011), in a cross-sectional controlled follow-up survey we compared written AD's of all live residents and a random sample of recently (since 1.7.10) deceased residents of the three co-operating nursing homes (n/hs) of our intervention region with corresponding random samples of similar size among the residents of 8 n/hs in our control regions. Primary endpoint is the prevalence of qualified ADs; an AD was regarded qualified if it included a decision on CPR, and carried a physician's signature. AD status of 235 live and 35 recently deceased residents in the intervention region was compared with that of 279 live and 36 deceased residents in the control region.

Results: In the comparison between intervention and control region, 56.7% vs. 26.0% had any written AD, 42.6% vs. 1.3% had an AD regarded helpful in case of sudden cardiac arrest, 38.3 vs. 5.7% were signed by a physician, and 37.8% vs. 0.6% fulfilled both criteria (p<0.001 for all comparisons).

Conclusion: The data confirm a sustained and relevant effect of the regional ACP program's implementation whereas qualified AD's seem rare exceptions elsewhere in German nursing homes.

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