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Obstacles to the delivery of primary palliative care as perceived by GPs

Centre for Quality of Care Research (114), Radboud University Nijmegen Medical Center, c.groot{at}kwazo.umcn.nl

Myrra J. F. J. Vernooij-Dassen

Centre for Quality of Care Research (114) and Vocational Training General Practitioners (229), Radboud University Nijmegen Medical Center, Nijmegen

Stans C. A. Verhagen

Department of Medical Oncology (550), Radboud University Nijmegen Medical Center, Nijmegen

Ben J. P. Crul

Pain Centre (520), Radboud University Nijmegen Medical Center, Nijmegen

Richard P. T. M. Grol

Centre for Quality of Care Research (114), Radboud University Nijmegen Medical Center, Nijmegen

Introduction: In order to facilitate GPs in their work and increase the possibilities for patients to remain at home, it is important to identify the obstacles which hinder the delivery of primary palliative care. From previous research we learned about some of the problems experienced by GPs. In this survey we aimed to identify the prevalence of such problems in providing palliative care and its determinants. Methods: The prevalence of obstacles and its determinants were identified by a questionnaire to 320 GPs in three regions of the Netherlands. Obstacles were grouped as follows: communication, organisation & co-ordination of care, knowledge & expertise, integrated care, time for relatives. The potential determinants were GP characteristics and expertise development activities. Results: The response rate was 62.3%. GPs experienced considerable obstacles in all aspects of palliative care. The most prevalent were: problems with bureaucratic procedures (83.9%), the time necessary to arrange home care technology (61.1%) and the difficulties accompanied with the wish or necessity to obtain extra care (56.3%). In general, more years of GP experience and the participation in (multidisciplinary) case discussions were associated with less perceived obstacles. Discussion: Based on the results of our survey policymakers and practitioners can plan and set priorities in handling the obstacles. There is a high necessity of firstly overcoming the barriers within organisation and coordination of care. Furthermore, our study can help in choosing the (additional) expertise needed in the future and in the realisation of the preferred expertise advancement activities. Palliative Medicine 2007; 21: 697—703

Key Words: obstacles • family • general practitioners • palliative care • physicians • primary care • quality improvements

Palliative Medicine, Vol. 21, No. 8, 697-703 (2007)
DOI: 10.1177/0269216307083384


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