Do Family Health Clinics Provide Primary-level Palliative Care in Ontario and the Eastern Regions of Quebec?

Overview

Journal Can Fam Physician

Specialties General Medicine
Public Health

Date 2019 Feb 16

PMID 30765362

Citations 3

Authors

Bruno Gagnon

Sandy Buchman

Anum Irfan Khan

Marnie MacKinnon

Sara Urowitz

Tara Walton

Marie Immacula Fabienne Cleophat-Jolicoeur

Jose Pereira

Affiliations

Soon will be listed here.

Abstract

Objective: To explore the extent to which family health clinics in Ontario and the eastern regions of the province of Quebec provide palliative care.

Design: A cross-sectional survey.

Setting: Ontario and the eastern regions of Quebec.

Participants: The clinic leads of a select group of family health clinics with patient enrolment models in Ontario and the eastern regions of Quebec.

Main Outcome Measures: The types of palliative care services that the clinics provide, as well as the enablers of and barriers to providing palliative care within the 2 provinces.

Results: The overall response rate was 32%. Clinics in both provinces reported providing palliative care to ambulatory patients (83% of Ontario clinics and 74% of Quebec clinics). Only 29 of 102 (28%) Ontario clinics provided on-call services themselves, compared with 31 of 34 (91%) Quebec clinics, with the resulting effect being that more patients were directed to emergency departments in Ontario. Access to palliative care specialist teams for support was higher in Ontario than in Quebec (67% vs 41%, respectively). In Ontario, 56% of practices indicated that they had access to palliative care physicians who could take over the care of their patients with palliative care needs, but a lower number (44%) actually handed over care to these physicians.

Conclusion: A group of clinics are providing full palliative care services to their own patients with palliative care needs, including "on-call" services and home visits, and these serve as role models. In Ontario in particular, substantial gaps still exist with respect to clinics providing their own after-hours coverage and home visits; many rely on other services to provide that care. In Quebec, lack of access to palliative care specialist teams appears to be a key challenge in the areas included in this survey. This survey could help policy makers and funders of health care services ensure that appropriate conditions are put in place for optimal palliative care provision in these clinics, such as coordinating access to on-call coverage and support from palliative care specialist teams, as well as providing education to all physicians and adequate remuneration.

Citing Articles

Family Physicians with Certificates of Added Competence in Palliative Care Contribute to Comprehensive Care in Their Communities: A Qualitative Descriptive Study.

Howard M, Fikree S, Allice I, Farag A, Siu H, Baker A Palliat Med Rep. 2023; 4(1):28-35.

PMID: 36910452 PMC: 9994442. DOI: 10.1089/pmr.2022.0057.

Co-designing Community Out-of-hours Palliative Care Services: A systematic literature search and review.

Low C, Namasivayam P, Barnett T Palliat Med. 2022; 37(1):40-60.

PMID: 36349547 PMC: 9843546. DOI: 10.1177/02692163221132089.

Palliative care physicians' motivations for models of practicing in the community: A qualitative descriptive study.

Maybee A, Winemaker S, Howard M, Seow H, Farag A, Park H Palliat Med. 2021; 36(1):181-188.

PMID: 34920682 PMC: 8793308. DOI: 10.1177/02692163211055022.

References

Murray S, Firth A, Schneider N, Van den Eynden B, Gomez-Batiste X, Brogaard T . Promoting palliative care in the community: production of the primary palliative care toolkit by the European Association of Palliative Care Taskforce in primary palliative care. Palliat Med. 2014; 29(2):101-11. DOI: 10.1177/0269216314545006. View

Seow H, Brazil K, Sussman J, Pereira J, Marshall D, Austin P . Impact of community based, specialist palliative care teams on hospitalisations and emergency department visits late in life and hospital deaths: a pooled analysis. BMJ. 2014; 348:g3496. PMC: 4048125. DOI: 10.1136/bmj.g3496. View

Klinger C, Howell D, Marshall D, Zakus D, Brazil K, Deber R . Resource utilization and cost analyses of home-based palliative care service provision: the Niagara West End-of-Life Shared-Care Project. Palliat Med. 2012; 27(2):115-22. DOI: 10.1177/0269216311433475. View

Almaawiy U, Pond G, Sussman J, Brazil K, Seow H . Are family physician visits and continuity of care associated with acute care use at end-of-life? A population-based cohort study of homecare cancer patients. Palliat Med. 2013; 28(2):176-83. DOI: 10.1177/0269216313493125. View

Osborn R, Moulds D, Schneider E, Doty M, Squires D, Sarnak D . Primary Care Physicians In Ten Countries Report Challenges Caring For Patients With Complex Health Needs. Health Aff (Millwood). 2015; 34(12):2104-12. DOI: 10.1377/hlthaff.2015.1018. View

Michiels E, Deschepper R, Kelen G, Bernheim J, Mortier F, Vander Stichele R . The role of general practitioners in continuity of care at the end of life: a qualitative study of terminally ill patients and their next of kin. Palliat Med. 2007; 21(5):409-15. DOI: 10.1177/0269216307078503. View

Meili R, Buchman S . Social accountability: at the heart of family medicine. Can Fam Physician. 2013; 59(4):335-6. PMC: 3625068. View

Neergaard M, Vedsted P, Olesen F, Sokolowski I, Jensen A, Sondergaard J . Associations between home death and GP involvement in palliative cancer care. Br J Gen Pract. 2009; 59(566):671-7. PMC: 2734355. DOI: 10.3399/bjgp09X454133. View

Quill T, Abernethy A . Generalist plus specialist palliative care--creating a more sustainable model. N Engl J Med. 2013; 368(13):1173-5. DOI: 10.1056/NEJMp1215620. View

10.

Norman A, Sisler J, Hack T, Harlos M . Family physicians and cancer care. Palliative care patients' perspectives. Can Fam Physician. 2001; 47:2009-12, 2015-6. PMC: 2018446. View

11.

Shadd J, Burge F, Stajduhar K, Cohen S, Kelley M, Pesut B . Defining and measuring a palliative approach in primary care. Can Fam Physician. 2013; 59(11):1149-50. PMC: 3828085. View

12.

Higginson I, Costantini M, Silber E, Burman R, Edmonds P . Evaluation of a new model of short-term palliative care for people severely affected with multiple sclerosis: a randomised fast-track trial to test timing of referral and how long the effect is maintained. Postgrad Med J. 2011; 87(1033):769-75. DOI: 10.1136/postgradmedj-2011-130290. View

13.

Temel J, Greer J, Muzikansky A, Gallagher E, Admane S, Jackson V . Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010; 363(8):733-42. DOI: 10.1056/NEJMoa1000678. View

14.

Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A . Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014; 383(9930):1721-30. DOI: 10.1016/S0140-6736(13)62416-2. View

15.

Traue D, Ross J . Palliative care in non-malignant diseases. J R Soc Med. 2005; 98(11):503-6. PMC: 1275998. DOI: 10.1177/014107680509801111. View

16.

Pivodic L, Harding R, Calanzani N, McCrone P, Hall S, Deliens L . Home care by general practitioners for cancer patients in the last 3 months of life: An epidemiological study of quality and associated factors. Palliat Med. 2015; 30(1):64-74. PMC: 4681160. DOI: 10.1177/0269216315589213. View

17.

Hauptman P, Havranek E . Integrating palliative care into heart failure care. Arch Intern Med. 2005; 165(4):374-8. DOI: 10.1001/archinte.165.4.374. View

18.

Marshall D, Howell D, Brazil K, Howard M, Taniguchi A . Enhancing family physician capacity to deliver quality palliative home care: an end-of-life, shared-care model. Can Fam Physician. 2008; 54(12):1703-1703.e7. PMC: 2602612. View

19.

Barbera L, Hwee J, Klinger C, Jembere N, Seow H, Pereira J . Identification of the physician workforce providing palliative care in Ontario using administrative claims data. CMAJ Open. 2015; 3(3):E292-8. PMC: 4593465. DOI: 10.9778/cmajo.20150005. View