Background
PPC ➣ Palliative homecare is mostly delivered as primary palliative care (PPC) [1]). ➣ PPC provided by General Practitioners (GPs) is often supported by nursing care services, ambulatory hospice services, etc. ➣ About 90% of patients at end of life can be sufficiently cared for with PPC, according to estimations of the German Association of Palliative Medicine [2]. | SPHC ➣ Specialised palliative homecare (SPHC) for patients with severe, advanced, life-limiting illnesses and complex symptoms is funded by the Social Health Insurance. ➣is provided by multi-professional teams (physicians, nurses, other professionals), delivering specialised palliative care at patients’ homes/ nursing homes etc. [3]. ➣ comprises care which in kind, severity and complexity can only be delivered by physicians with extra palliative qualifications, as well as 24-h availability. ➣ requires a referral from GPs, primary care specialists or upon discharge from hospital. ➣ main indications are complex, pronounced symptoms such as neurological, psychiatric or psychological, respiratory or cardiac symptoms, ulcerating wounds or tumours. |
Methods
Hypothesis/Theory
Study design
Survey setting and sample
Instrument
Data collection and consent of participants
Data analysis
Results
Characteristics of respondents
Characteristics | Value | |||
---|---|---|---|---|
Respondents - n | 1026 | |||
Age - years Mean ± SD | 54.1 ± 9.4 | |||
Gender - n (%) | ||||
Male | 502 (49.0) | |||
Female | 520 (50.8) | |||
Work experience in the outpatient sector - years Mean ± SD | 20.2 ± 11.2 | |||
Working hours/week - Mean ± SD | 46.9 ± 12.4 | |||
Practice type - n (%) | ||||
Single-handed | 510 (49.8) | |||
Group practice | 467 (45.6) | |||
Medical care centre | 47 (4.6) | |||
Employed - n (%) | ||||
Yes | 123 (12.0) | |||
No | 887 (86.6) | |||
Location of practice - n (%) | ||||
Rural (≤ 5,000 inhabitants) | 264 (25.8) | |||
Small town (> 5,000–20,000 inhabitants) | 290 (28.3) | |||
Medium-sized town (> 20,000–100,000 inhabitants) | 198 (19.3) | |||
Big city (> 100,000 inhabitants) | 264 (25.8) | |||
Number of patients/quarter - Mean ± SD | 1130.3 ± 373.3 | |||
Number of palliative patients/year - Mean ± SD | 18.4 ± 26.8 | |||
Number of home visits/week - Mean ± SD | 15.3 ± 20.6 | |||
Number of home visits/quarter within palliative patients - Mean ± SD | 15.1 ± 25.5 | |||
GPs’ attitude towards palliative care | ||||
bad | … | … | good | |
Please assess your overall palliative competence/expertise! - n (%) | 20 (2.0) | 90 (8.8) | 533 (52.1) | 350 (34.2) |
not true | rather not true | rather true | completly true | |
Care of severe sick and dying patients should be a central part of GPs work. - n (%) | 34 (3.3) | 106 (10.4) | 219 (21.4) | 657 (64.2) |
SPHC referral practice | ||||
Have you ever referred SPHC (within your work as a GP)? | ||||
Yes - n (%) | 847 (83.7) | |||
No - n (%) | 163 (15.9) | |||
Number of GPs’ SPHC referrals (follow-up referrals included) - Mean ± SD | 8.8 ± 11.9 | |||
Number of SPHC referrals by other health care professionals - Mean ± SD | 3.7 ± 5.2 | |||
never | … | … | always | |
Do you regularly stay involved in palliative patients’ treatment after SPHC initiation? - n (%) | 53 (5.2) | 174 (17.0) | 298 (29.1) | 356 (34.8) |
How often is one of your SPHC referrals denied (by MDK)? - n (%) | 653 (63.8) | 166 (16.2) | 31 (3.0) | 0 |
GPs’ evaluation of SPHC importance
Factors influencing GPs’ perception of the importance of SPHC
Variable | Regression Coefficient β | Significance | 95% Confidence Interval | Standard Error | n |
---|---|---|---|---|---|
Age | −.002 | .238 | −.006; .001 | .002 | 954 |
Gender (Reference: male) | .158 | <.001 | .093; .223 | .033 | 955 |
Work experience (years) | −.003 | .023 | −.006; −4.8*10^(−4) | .002 | 948 |
Working hours/week | −.005 | <.001 | −.008; −.002 | .001 | 944 |
Practice Type (Reference: medical care centre) | 956 | ||||
Single-handed | −.123 | .128 | −.281; .035 | .081 | |
Group practice | −.123 | .128 | −.282; .035 | .081 | |
Employed (reference: yes) | −.064 | .218 | −.165; .038 | .052 | 943 |
Location of practice (reference: big city) | 949 | ||||
Rural | −.084 | .070 | −.176; .007 | .047 | |
Small town | −.057 | .212 | −.147; .033 | .046 | |
Medium-sized town | −.078 | .124 | −.177; .021 | .050 | |
Affiliation to Federal State (association of Statuatory Health Insurance Physicians, reference: Westphalia-Lippe) | 956 | ||||
Bavaria | .039 | .561 | −.093; .171 | .067 | |
Berlin | .227 | .003 | .076; .378 | .077 | |
Hesse | .144 | .040 | .006; .282 | .070 | |
Lower Saxony | .108 | .133 | −.033; .248 | .072 | |
Saxony-Anhalt | .068 | .313 | −.064; .200 | .067 | |
Schleswig-Holstein | .083 | .235 | −.054; .220 | .070 | |
Thuringia | .122 | .056 | −.003; .247 | .064 | |
Number of patients/quarter | −9.08*10^(−5) | .048 | −1.81*10^(−4) | −7.68*10^(−7) | 910 |
Number of palliative patients/year | −.001 | .081 | −.002; 1.40*10^(− 4) | .001 | 940 |
Number of home visits/week | −.001 | .096 | −.003; 2.42*10^(− 4) | .001 | 954 |
Number of home visits/quarter within palliative patients | −3.27*10^(−4) | .051 | −.001; 1.46*10^(−6) | 1.67*10^(− 4) | 937 |
Conviction that palliative care should be a central part of GP’s work | −.145 | <.001 | −.185; −.106 | .020 | 949 |
Self-assessed palliative competence | −.182 | <.001 | −.230; −.135 | .024 | 939 |
Extent of GP palliative care delivery (index) | −.334 | <.001 | −.395; −.272 | .031 | 954 |
Perceived involvement in treatment after SPHC initiation | .116 | <.001 | .080; .152 | .018 | 836 |
Frequency of SPHC referrals denied by MDKa | .017 | .617 | −.049; .082 | .033 | 811 |
Number of SPHC referrals by other health care professionals | −.007 | .035 | −.014; −.001 | .003 | 756 |
Qualification level (Reference: none + exclusively within work in general practice) | 921 | ||||
Additional qualification in palliative care | −.080 | .158 | −.191; .031 | .057 | |
BQKPmVb | −.337 | .084 | −.720; .045 | .195 | |
40 h-course certificate | −.068 | .154 | −.161; .025 | .047 | |
Having worked in a palliative care institution for at least 3 months | .069 | .342 | −.073; .210 | .072 | |
Remuneration level (Reference: PPC) | 956 | ||||
Settlement via selective contracts | −.087 | .168 | −.212; .037 | .063 | |
BQKPmV | −.399 | .008 | −.693; −.105 | .150 | |
PPC + additional qualification in palliative care | −.081 | .201 | −.204; .043 | .063 | |
Quality of surrounding palliative infrastructure | .121 | .003 | .042; .201 | .041 | 869 |
Quality of utilised SPHC | .241 | <.001 | .187; .294 | .027 | 811 |
Variable | Regression Coefficient β | Signifi-cance | 95% Confidence Interval | Standard Error |
---|---|---|---|---|
(Constant) | 2.30 | <.001 | 1.69; 2.92 | .315 |
Extent of GP palliative care delivery (index) | −.283 | <.001 | −.384; −.182 | .051 |
Conviction that palliative care should be a central part of GPs' work | −.062 | .025 | −.116; −.008 | .027 |
Perceived involvement in treatment of palliative patients after SPHC initiation | .088 | <.001 | .042; .134 | .023 |
Quality of utilised SPHC | .119 | .001 | .048; .190 | .036 |