Ewertowski Helen, Hesse Anja Katharina, Schneider Nils, Stiel Stephanie
Institut für Allgemeinmedizin, Medizinische Hochschule Hannover.
Institut für Allgemeinmedizin, Medizinische Hochschule Hannover.
Z Evid Fortbild Qual Gesundhwes. 2019 Dec;149:32-39. doi: 10.1016/j.zefq.2019.12.003. Epub 2020 Feb 12.
General practitioners (GPs) make a major contribution to outpatient palliative care (AAPV). In 2013, new fee rates for AAPV were included in the uniform assessment standard, which strengthens the financial framework conditions for outpatient palliative care by GPs. The aim of the ALLPRAX project is to improve the framework conditions for AAPV. This contribution focusses on ideas for changing structural, legal, and financial framework conditions for an optimised AAPV.
In April 2018, 28 healthcare professionals (10 GPs, 3 medical assistants, 3 hospital doctors, and 12 representatives of the nursing professions) from hospice and palliative care providers in Lower Saxony were invited to participate in nine group discussions at Hannover Medical School. During these group discussions, inhibitory factors for AAPV and possible solutions were discussed. The analysis of the group discussions was carried out using a summarizing content analysis according to Mayring.
In order to optimise palliative care by GPs in Germany, it is proposed that a) additional palliative care specialists for care coordination and round-the-clock availability for patients and relatives in GP practices should be provided (structural solution), b) nursing staff should be permitted to prescribe aids (legal solution), and c) higher remuneration for medical consultations should be provided (financial solution). These approaches could increase feasibility in day-to-day practice and create incentives for caregivers to provide more high-quality general outpatient palliative care.
The described high expenditure in general outpatient palliative care, which is hardly inferior to specialised outpatient palliative care from the caregivers' point of view, is not reflected accordingly, neither structurally nor financially.
In order to optimise general outpatient palliative care, structural, legal and financial framework conditions need to be correspondingly adapted.
全科医生（GP）对门诊姑息治疗（AAPV）做出了重大贡献。2013年，AAPV的新收费标准被纳入统一评估标准，这加强了全科医生门诊姑息治疗的财务框架条件。ALLPRAX项目的目的是改善AAPV的框架条件。本论文着重探讨优化AAPV的结构、法律和财务框架条件的思路。
2018年4月，来自下萨克森州临终关怀和姑息治疗机构的28名医疗保健专业人员（10名全科医生、3名医疗助理、3名医院医生和12名护理专业代表）受邀参加在汉诺威医学院举行的9次小组讨论。在这些小组讨论中，探讨了AAPV的抑制因素和可能的解决方案。小组讨论的分析采用了根据迈林提出的总结性内容分析法。
为了优化德国全科医生的姑息治疗，建议：a）应提供额外的姑息治疗专家，以协调护理工作，并为全科医生诊所的患者及其亲属提供全天候服务（结构解决方案）；b）应允许护理人员开辅助器具处方（法律解决方案）；c）应提高医疗咨询的报酬（财务解决方案）。这些方法可以增加日常实践中的可行性，并激励护理人员提供更高质量的全科门诊姑息治疗。
从护理人员的角度来看，全科门诊姑息治疗的高支出几乎不亚于专科门诊姑息治疗，但在结构和财务上都没有得到相应体现。
为了优化全科门诊姑息治疗，结构、法律和财务框架条件需要相应调整。
