Background In Ireland there are no formal frameworks to support primary care teams to identify and respond to the palliative care needs of their patients.
Aims As part of the Primary Palliative Care programme, the Irish Hospice Foundation, Irish College of General Practitioners and Health Service Executive surveyed GPs, Community Nursing (CN) and Allied Health Professionals (AHPs) to establish initiatives that would support the care for patients facing death in the community.
Methods Formal views were gathered from staff through consultation meetings (5) and subsequent distribution of questionnaires (685). Palliative care themes addressed included education, medication, patient pathways, communication and non-cancer. 105 staff participated in the consultation meetings and the questionnaires had a 27% (n=127) response rate.
Results The initiatives identified that directly benefit patient care included: introducing an electronic hand-over form between GP and out-of-hours services (78%); guidance in management of palliative medications (48%) and introducing a system for primary care teams to identify patients with palliative care needs (38%). From an education perspective, training in symptom control (66%) and palliative care for non-malignant disease (40%) were highly rated by all professions. The service enhancements identified, that have resource implications include: timely access to equipment (87%); greater access to OOH community nursing (73%); improved access to psychological support for patients/families (71%) and access to advice and information from specialist palliative care outside traditional hours (69%).
Conclusions Community healthcare professionals recognise the role they play in responding to patient's palliative care needs. The challenges and education deficits identified were broadly in keeping with data available from other countries. Enhancing co-ordinated and communication of care as well as the role for palliative care for patients with non-malignant disease require attention. More resources are required to ensure fully responsive and holistic primary care service for patients dying in the community.
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