This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Groot, M. M. Articles by Grol, R. P. T. M. Search for Related Content PubMed PubMed Citation Articles by Groot, M. M. Articles by Grol, R. P. T. M. Pubmed/NCBI databases Medline Plus Health Information Choosing a Doctor or Health Care Service Palliative Care Social Bookmarking                         What's this?

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

References

• National Institute of Public Health and the Environment [RIVM]. The National Public Health Compass [Nationaal Kompas Volksgezondheid]. Bilthoven, the Netherlands; 2004 Feb 26. Report No.: version 2.6 [versie 2.6].
• Francke AL, Willems DL Palliative care today and tomorrow. Facts, views and scenarios. [in Dutch] [Palliatieve zorg vandaag en morgen. Feiten, opvattingen en scenario's]. Elsevier Gezondheidszorg, 2000.
• Lloyd-Williams M., Wilkinson C., Lloyd-Williams F. General practitioners in North Wales: current experiences of palliative care. Eur J Cancer Care (Engl) 2000; 9(3): 138—43.[CrossRef][Medline] [Order article via Infotrieve]
• Groot MM, Vernooij-Dassen MJFJ, Crul BJP, Grol RPTM. General practitioners (GPs) and palliative care: perceived tasks and barriers in daily practice. Palliative Medicine 2005; 19(2): 111—8.[Abstract/Free Full Text]
• Kenyon Z. Palliative care in general practice. BMJ 1995; 311(7010): 888—9.[Free Full Text]
• Schuit KW Thesis. Palliative care in general practice University of Groningen, the Netherlands, 1999.
• Walsh D., Regan J. Terminal care in the home: the general practice perspective. Ir Med J 2001; 94(1): 9—11.[Medline] [Order article via Infotrieve]
• Palliative care: the solid facts. Copenhagen, Denmark: WHO Regional Office for Europe, 2004.
• Higginson IJ, Sen-Gupta GJ Place of care in advanced cancer: a qualitative systematic literature review of patient preferences. J Palliat Med 2000; 3(3): 287—300.[CrossRef][Medline] [Order article via Infotrieve]
• McWhinney IR, Bass MJ, Orr V. Factors associated with location of death (home or hospital) of patients referred to a palliative care team. CMAJ 1995; 152(3): 361—7.[Abstract]
• Blyth AC Audit of terminal care in general practice. Br Medi J 1990; 300: 983—6.
• Cartwright A. Balance of care for the dying between hospitals and the community: perceptions of general practitioners, hospital consultants, community nurses and relatives. Br J Gen Pract 1991; 41(348): 271—4.[Web of Science][Medline] [Order article via Infotrieve]
• Tang ST, McCorkle R. Determinants of place of death for terminal cancer patients. Cancer Invest 2001; 19(2): 165—80.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Schrijvers Ajp Health and health care in the Netherlands. A critical self-assessment by Dutch experts in the medical and health sciences. De Tijdstroom BV, 1997.
• Davies E. What are the palliative care needs of older people and how might they be met? WHO Regional Office for Europe (Health Evidence Network report), 2004.
• Statistics Netherlands Website. 2004. www.cbs.nl [visited: 2004]. Voorburg/ Heerlen.
• The Gold Standards Framework. A programme for community palliative care. 2007. www.goldstandardsframework.nhs.uk [visited 100107]
• The Liverpool Care Pathway: Promoting best practice for care of the dying. http://www.lcp-mariecurie.org.uk/. 2007.
• Grol R. Personal paper. Beliefs and evidence in changing clinical practice. BMJ 1997; 315(7105): 418—21.[Free Full Text]
• Grol R., Wensing M. et al. Implementation. Effective change in patientcare [in Dutch] [Implementatie: effectieve verandering in de patientenzorg], second edition, Elsevier healthcare, 2001.
• National Council for Public Health Care [Nationale Raad voor de Volksgezondheid]. Transmural somatic care [in Dutch] [Transmurale somatische zorg]. Zoetermeer, 1995.
• Oliver D. Training in palliative care. Br J Gen Prac 1998; 48(428): 1095.[Web of Science][Medline] [Order article via Infotrieve]
• Fischer SM Palliative care education: an intervention to improve medical residents' knowledge and attitudes. J-Palliat-Medi 2003; 6(3): 391—9.
• Wensing M., Grol R. Educational interventions [in Dutch] [Educatieve interventies]. In Grol R, Wensing M, eds. Implementation. Effective changes in patient care [in Dutch] [Implementatie. Effectieve verandering in de patiëntenzorg], second edition. Elsevier Healthcare, 2001: 227—42.
• Smeenk Fwm, de Witte LP, van Haastregt Jcm, Schipper RM, Biezemans Hph, Crebolder Hfjm. Transmural care. A new approach in the care for terminal cancer patients: its effects on re-hospitalization and quality of life. Patient Education and Counseling 1998; 35(3): 189—99.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Committee on modernisation curative care [in Dutch] [Commissie modernisering curatieve zorg]. Shared care; better care. [in Dutch] [Gedeelde zorg; betere zorg]. Zoetermeer, 1994.
• Brazil K., Bedard M., Willison K., Hode M. Caregiving and its impact on familes of the terminally ill. Ageing Mental Health 2003; 7(5): 376—82.[CrossRef]
• de Korte Verhoef MC Final report about 5 years centres for the development of palliative care (COPZ) [in Dutch]. [Eindrapport Toetsingscommissie COPZ; Vijf jaar Centra voor Ontwikkeling van Palliatieve Zorg] The Hague, 2004 May 7.
• Groot MM, Vernooij-Dassen MJ, Courtens A., Kuin A., van der Linden B., van Zuylen C. et al. Requests from professional care providers for consultation with palliative care consultation teams (PCC teams). Supportive Care Cancer 2005; 13: 920—28.[CrossRef]

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


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Groot, M. M. Articles by Grol, R. P. T. M. Search for Related Content PubMed PubMed Citation Articles by Groot, M. M. Articles by Grol, R. P. T. M. Pubmed/NCBI databases Medline Plus Health Information Choosing a Doctor or Health Care Service Palliative Care Social Bookmarking                         What's this?