Marx Gabriella, Schwabe Sven, Kuba Sarah, Weber Jan Philip, Pohontsch Nadine Janis, Schade Franziska, Scherer Martin, Schneider Nils
Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany.
BMJ Open. 2025 Aug 25;15(8):e097181. doi: 10.1136/bmjopen-2024-097181.
Patients with progressive chronic non-malignant diseases (CNMD) such as chronic obstructive pulmonary disease, congestive heart failure and dementia could benefit from specialist palliative home care (SPHC). The two-arm, cluster randomised controlled KOPAL trial was conducted to test the effectiveness of a timely SPHC nurse-patient consultation followed by an interprofessional telephone case conference between general practitioners and SPHC teams. This study was a component of the KOPAL trial and aims to explore general practitioners' (GP) experiences with treating CNMD patients before and with case conferences and with the following consequences for treatment and interprofessional collaboration with SPHC teams.
Qualitative evaluation of the KOPAL trial focussing on GPs' perspective. Open guided interviews using narrative techniques analysed with grounded theory.
The KOPAL trial was conducted in Lower Saxony and the metropolitan region of Hamburg, Germany.
24 GPs who participated in the intervention group of the trial were interviewed.
Findings show that GPs have practice-specific routines when caring for people with CNMD. Interprofessional case conferences may lead to more awareness regarding gaps in primary palliative care, one's own care routines or a lack of psychosocial support. Although gaining new insights, GPs follow three different strategies following the case conferences: (1) Maintain routines of care and disregard added value, (2) extend routines of care according to SPHC advice and (3) integration and partial change of care routines caused by SPHC support. These strategies are influenced by GPs' perception of SPHC teams (eg, ambivalence towards SPHC).
Interprofessional case conferences to timely discuss care options could improve healthcare for patients with advanced CNMD by revealing gaps in care. Promoting a regular process of exchange between GPs and SPHC teams (such as through round tables) may improve a trusting cooperation.
DRKSS00017795.
患有慢性阻塞性肺疾病、充血性心力衰竭和痴呆等进行性慢性非恶性疾病（CNMD）的患者可从专科姑息家庭护理（SPHC）中获益。开展了双臂整群随机对照的KOPAL试验，以检验及时进行SPHC护士-患者咨询，随后由全科医生与SPHC团队进行跨专业电话病例讨论会的有效性。本研究是KOPAL试验的一个组成部分，旨在探讨全科医生（GP）在病例讨论会前后治疗CNMD患者的经历，以及对治疗和与SPHC团队跨专业协作的后续影响。
对KOPAL试验进行定性评估，重点关注全科医生的观点。采用叙事技巧进行开放式引导访谈，并运用扎根理论进行分析。
KOPAL试验在德国下萨克森州和汉堡大都市地区开展。
对参与试验干预组的24名全科医生进行了访谈。
研究结果表明，全科医生在护理CNMD患者时有特定于实践的常规做法。跨专业病例讨论会可能会使人们对初级姑息治疗中的差距、自身护理常规或缺乏心理社会支持有更多认识。尽管获得了新的见解，但全科医生在病例讨论会之后采取三种不同的策略：（1）维持护理常规，忽视附加价值；（2）根据SPHC的建议扩展护理常规；（3）因SPHC的支持而整合并部分改变护理常规。这些策略受到全科医生对SPHC团队的认知（例如，对SPHC的矛盾态度）的影响。
及时讨论护理方案的跨专业病例讨论会可通过揭示护理差距来改善晚期CNMD患者的医疗保健。促进全科医生与SPHC团队之间定期的交流过程（例如通过圆桌会议）可能会改善信任合作。
DRKSS00017795。
