Carmont Sue-Ann, Mitchell Geoffrey, Senior Hugh, Foster Michele
The University of Queensland, Brisbane, Queensland, Australia.
Massey University, Auckland, New Zealand.
BMJ Support Palliat Care. 2018 Dec;8(4):385-399. doi: 10.1136/bmjspcare-2016-001125. Epub 2017 Feb 14.
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.
(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.
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.
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.
This is an emerging field and further research is required assessing the effectiveness of different models of integrated palliative care.
全科医生（GP）在姑息治疗综合模式中发挥着关键作用，因为他们通常非常了解患者及其照顾者，是全科医疗的专家，并且熟悉社区的健康和社会服务。专科姑息治疗服务能力不足，无法满足需求，患有非癌症终末期疾病的患者以及来自农村和偏远地区的患者未得到充分服务。研究重点是通过让全科医生参与综合姑息治疗中的专科二级服务来改善姑息治疗的可及性。
（1）评估旨在让全科医生和专科二级服务参与综合姑息治疗的干预措施的有效性；（2）确定综合姑息治疗的个人、系统和结构障碍及促进因素。
检索了MEDLINE、EMBASE和CINAHL。纳入任何关于在提供姑息治疗中让全科医生与专科二级服务合作的服务研究。全科医生的参与被定义为全科医生与专科二级服务在患者护理方面的任何有组织的合作，包括联合咨询、至少涉及全科医生和专科临床医生及/或其他二级服务的病例讨论会，和/或全科医生与专科服务之间的任何正式共享护理安排。专科二级服务要么是专科姑息治疗服务，要么是为姑息治疗人群提供专科护理的服务。采用叙述性框架来描述研究结果。
纳入了17项研究。有一些证据表明综合姑息治疗可以减少住院次数并维持功能状态。提供综合护理存在重大障碍。讨论了提供综合姑息治疗的原则和促进因素。
这是一个新兴领域，需要进一步研究评估不同综合姑息治疗模式的有效性。
