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33% of Primary Care Providers Also Deliver Palliative Care

Primary care providers practicing in a patient-centered medical home are the most likely to deliver at least some palliative care services.

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Source: Thinkstock

By Sara Heath

- About one-third of primary care physicians offer palliative care services, allaying some concern about a growing senior patient population and a shrinking palliative care workforce, according to research published in the Journal of the American Board of Family Medicine.

According to the research team, the number of older adult patients needing palliative and patient-centered end-of-life care will increased from 46 million to 69 million between 2015 and 2030. This influx of older patients, who due to medical advances will experience “a prolonged trajectory of dying,” will require extensive palliative care.

With more patients needing patient-centered end-of-life care, it will be increasingly important for primary care providers to assume part of these duties, the research team asserted. However, prior to this study it was unclear how much of the primary care workforce was already delivering palliative care services.

The research team conduced a cross-sectional analysis of responses from the 2013 American Board of Family Medicine Maintenance of Certification and Demographic Survey to determine the number of primary care physicians delivering some palliative care services.

Of the 10,894 family physicians surveyed, 33 percent reported that they provide at least some palliative care. Physicians seeing patients in hospice, nursing homes, or during home visits were more likely to deliver palliative care than physicians conducting in-office visits with patients.

Other characteristics that predicted palliative care delivery included practicing in western or rural areas and practicing in or applying for patient-centered medical home certification. Older, white, male physicians were also more likely to deliver palliative care than other demographics, the researchers reported.

The varying demographics for primary care physicians delivering palliative care are concerning, according to the researchers. Industry leaders should be concerned that older, white, male providers in rural areas are the most likely population to deliver palliative care, the researchers pointed out. With such a restricted clinician base offering these services, patients may see their palliative treatment options wane in the future.

However, the researchers did see some promise in the results. As noted above, providers practicing in or applying for patient-centered medical home certification were 1.73 times more likely to deliver palliative care than those who were not associated with a patient-centered medical home.

“It is reassuring that those with or pursuing PCMH certification are more likely to report palliative care provision given the current policy emphasis on supporting PCMHs,” the researchers said.

Going forward, researchers will need to determine how they can encourage more primary care physicians to deliver palliative care, especially in the wake of a growing senior patient population. Although it is promising that one-third of primary care physicians deliver palliative care, it will be key for more to adopt the practice to ensure patients have adequate access to these services.

In November 2016, the JABFM published other research findings suggesting the importance of primary care physicians in driving palliative care availability.

Currently, there are not enough palliative care specialists for the number of patients needing those services.

“Palliative care specialists cannot meet the palliative needs of all people with serious illness because of limitations of reimbursement for the delivery of non-hospice palliative services; limitations of hospice eligibility to the last months of life, despite the patient suffering that occurs throughout the trajectory of the illness; and a lack of adequate numbers of palliative specialists,” explained the researchers in the 2016 report.

Healthcare professionals are increasingly recognizing the importance of primary care providers in delivering some palliative care services. Specifically, primary care physicians are well-suited to offering some basic palliative services, such as pain and symptom management, depression and anxiety management, prognosis and treatment discussion, and advance care planning.

However, through qualitative telephone surveys, the research team found that many primary care providers felt ill-prepared to deliver palliative care services, especially aspects about advance care planning.

“Most saw these conversations as challenging at times, usually because of a patient’s or family’s resistance in acknowledging the realities of declining disease trajectories and sometimes because of the positive interpretations patients took from conversations with medical specialists,” the researchers explained.

Ultimately, primary care providers reported that with proper training and financial support, aspects of palliative care did have a place in the primary care office.

“Careful attention should be paid to the multidimensional, patient-focused, specialist palliative approach during this evolution,” the researchers concluded. “Adapting that approach and implementing it systematically in primary care practices to provide basic supportive care alongside appropriate disease management may better meet the triple aim.”

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