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Systematic review of the effectiveness, barriers and facilitators to general practitioner engagement with specialist secondary services in integrated palliative care
  1. Sue-Ann Carmont1,
  2. Geoffrey Mitchell1,
  3. Hugh Senior1,2 and
  4. Michele Foster1,3
  1. 1The University of Queensland, Brisbane, Queensland, Australia
  2. 2Massey University, Auckland, New Zealand
  3. 3Griffith University, Brisbane, Queensland, Australia
  1. Correspondence to Sue-Ann Carmont, School of Medicine, The University of Queensland, lvl 8, Health Sciences Building, Herston, QLD 4006, Australia; s.carmont{at}uq.edu.au

Abstract

The general practitioner (GP) has a critical role in an integrated model of palliative care as they often know the patient and carer well, are experts in generalist care and have knowledge of health and social services in the community. Specialist palliative services have insufficient capacity to meet demand and those with non-cancer terminal conditions and those from rural and remote areas are underserved. Research has focused on improving access to palliative care by engaging the GP with specialist secondary services in integrated palliative care.

Objectives (1) Evaluate the effectiveness of interventions designed to engage GPs and specialist secondary services in integrated palliative care; and (2) identify the personal, system and structural barriers and facilitators to integrated palliative care.

Method MEDLINE, EMBASE and CINAHL were searched. Any study of a service that engaged the GP with specialist secondary services in the provision of palliative care was included. GP engagement was defined as any organised cooperation between the GP and specialist secondary services in the care of the patient including shared consultations, case conferences that involved at least both the GP and the specialist clinician and/or other secondary services, and/or any formal shared care arrangements between the GP and specialist services. The specialist secondary service is either a specialist palliative service or a service providing specialist care to a palliative population. A narrative framework was used to describe the findings.

Results 17 studies were included. There is some evidence that integrated palliative care can reduce hospitalisations and maintain functional status. There are substantial barriers to providing integrated care. Principles and facilitators of the provision of integrated palliative care are discussed.

Conclusions This is an emerging field and further research is required assessing the effectiveness of different models of integrated palliative care.

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  • Received 7 February 2016.
  • Revision received 8 December 2016.
  • Accepted 19 January 2017.
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Footnotes

  • Contributors SC, GM, HS and MF planned the study. SC conducted the search. SC, GM and HS reviewed the included research. SC, GM, HS and MF contributed to the final manuscript and are responsible for the content. SC submitted the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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