Groot Marieke M, Vernooij-Dassen Myrra J F J, Verhagen Stans C A, Crul Ben J P, Grol Richard P T M
Centre for Quality of Care Research (114), Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Palliat Med. 2007 Dec;21(8):697-703. doi: 10.1177/0269216307083384.
In order to facilitate GPs in their work and increase the possibilities for patients to remain at home, it is important to identify the obstacles which hinder the delivery of primary palliative care. From previous research we learned about some of the problems experienced by GPs. In this survey we aimed to identify the prevalence of such problems in providing palliative care and its determinants.
The prevalence of obstacles and its determinants were identified by a questionnaire to 320 GPs in three regions of the Netherlands. Obstacles were grouped as follows: communication, organisation & co-ordination of care, knowledge & expertise, integrated care, time for relatives. The potential determinants were GP characteristics and expertise development activities.
The response rate was 62.3%. GPs experienced considerable obstacles in all aspects of palliative care. The most prevalent were: problems with bureaucratic procedures (83.9%), the time necessary to arrange home care technology (61.1%) and the difficulties accompanied with the wish or necessity to obtain extra care (56.3%). In general, more years of GP experience and the participation in (multidisciplinary) case discussions were associated with less perceived obstacles.
Based on the results of our survey policymakers and practitioners can plan and set priorities in handling the obstacles. There is a high necessity of firstly overcoming the barriers within organisation and coordination of care. Furthermore, our study can help in choosing the (additional) expertise needed in the future and in the realisation of the preferred expertise advancement activities.
为了方便全科医生开展工作并增加患者居家的可能性，识别阻碍初级姑息治疗提供的障碍很重要。从先前的研究中我们了解到全科医生遇到的一些问题。在本次调查中，我们旨在确定此类问题在提供姑息治疗中的发生率及其决定因素。
通过对荷兰三个地区的320名全科医生进行问卷调查，确定障碍的发生率及其决定因素。障碍分为以下几类：沟通、护理的组织与协调、知识与专业技能、综合护理、陪伴亲属的时间。潜在的决定因素是全科医生的特征和专业技能发展活动。
回复率为62.3%。全科医生在姑息治疗的各个方面都遇到了相当大的障碍。最普遍的是：官僚程序问题（83.9%）、安排家庭护理技术所需的时间（61.1%）以及因希望或需要获得额外护理而带来的困难（56.3%）。一般来说，全科医生的工作年限越长以及参与（多学科）病例讨论会与较少的感知障碍相关。
基于我们的调查结果，政策制定者和从业者可以在处理障碍方面进行规划并确定优先事项。首先克服护理组织与协调方面的障碍非常必要。此外，我们的研究有助于选择未来所需的（额外）专业技能以及实现首选的专业技能提升活动。
