About one-third of primary care physicians offer palliative care services, allaying some concern about a growing senior patient population and a shrinking palliative care workforce, according to research published in the Journal of the American Board of Family Medicine.

According to the research team, the number of older adult patients needing palliative and patient-centered end-of-life care will increased from 46 million to 69 million between 2015 and 2030. This influx of older patients, who due to medical advances will experience “a prolonged trajectory of dying,” will require extensive palliative care.

With more patients needing patient-centered end-of-life care, it will be increasingly important for primary care providers to assume part of these duties, the research team asserted. However, prior to this study it was unclear how much of the primary care workforce was already delivering palliative care services.

The research team conduced a cross-sectional analysis of responses from the 2013 American Board of Family Medicine Maintenance of Certification and Demographic Survey to determine the number of primary care physicians delivering some palliative care services.

Of the 10,894 family physicians surveyed, 33 percent reported that they provide at least some palliative care. Physicians seeing patients in hospice, nursing homes, or during home visits were more likely to deliver palliative care than physicians conducting in-office visits with patients.

Other characteristics that predicted palliative care delivery included practicing in western or rural areas and practicing in or applying for patient-centered medical home certification. Older, white, male physicians were also more likely to deliver palliative care than other demographics, the researchers reported.

The varying demographics for primary care physicians delivering palliative care are concerning, according to the researchers. Industry leaders should be concerned that older, white, male providers in rural areas are the most likely population to deliver palliative care, the researchers pointed out. With such a restricted clinician base offering these services, patients may see their palliative treatment options wane in the future.

However, the researchers did see some promise in the results. As noted above, providers practicing in or applying for patient-centered medical home certification were 1.73 times more likely to deliver palliative care than those who were not associated with a patient-centered medical home.

“It is reassuring that those with or pursuing PCMH certification are more likely to report palliative care provision given the current policy emphasis on supporting PCMHs,” the researchers said.

Going forward, researchers will need to determine how they can encourage more primary care physicians to deliver palliative care, especially in the wake of a growing senior patient population. Although it is promising that one-third of primary care physicians deliver palliative care, it will be key for more to adopt the practice to ensure patients have adequate access to these services.

In November 2016, the JABFM published other research findings suggesting the importance of primary care physicians in driving palliative care availability.

Currently, there are not enough palliative care specialists for the number of patients needing those services.

“Palliative care specialists cannot meet the palliative needs of all people with serious illness because of limitations of reimbursement for the delivery of non-hospice palliative services; limitations of hospice eligibility to the last months of life, despite the patient suffering that occurs throughout the trajectory of the illness; and a lack of adequate numbers of palliative specialists,” explained the researchers in the 2016 report.

Healthcare professionals are increasingly recognizing the importance of primary care providers in delivering some palliative care services. Specifically, primary care physicians are well-suited to offering some basic palliative services, such as pain and symptom management, depression and anxiety management, prognosis and treatment discussion, and advance care planning.

However, through qualitative telephone surveys, the research team found that many primary care providers felt ill-prepared to deliver palliative care services, especially aspects about advance care planning.

“Most saw these conversations as challenging at times, usually because of a patient’s or family’s resistance in acknowledging the realities of declining disease trajectories and sometimes because of the positive interpretations patients took from conversations with medical specialists,” the researchers explained.

Ultimately, primary care providers reported that with proper training and financial support, aspects of palliative care did have a place in the primary care office.

“Careful attention should be paid to the multidimensional, patient-focused, specialist palliative approach during this evolution,” the researchers concluded. “Adapting that approach and implementing it systematically in primary care practices to provide basic supportive care alongside appropriate disease management may better meet the triple aim.”

Source: patientengagementhit.com

Medical schools working to close the primary care gap often find themselves struggling against barriers of their own making.

The ongoing shortage of primary care physicians remains a concern across the medical industry, and med schools have historically harbored a cynical view of primary care, to the point where some elite medical schools don’t even bother with departments of family medicine.

That has meant students actively seeking a career in primary care commonly experience a less-than-encouraging academic atmosphere, according to a recent article in Medical Economics. “I definitely got messages along the way where I could tell people had the attitude of, ‘it’s fine if you want to do that, but it’s not anything impressive,’” said Diana Huang, a student at the Lewis Katz School of Medicine at Temple University, describing the lukewarm response she received from the medical school community regarding her chosen specialty.

The article points to a relative lack of mentors and role models for aspiring primary care physicians, whether due to burnout or existing biases among medical school administrators and faculty members. The article describes this phenomenon as advancing a “hidden curriculum” that marginalizes primary care.

As an internist, Stuart Markowitz, M.D., senior associate dean for student affairs and admissions at Florida Atlantic University’s Charles E. Schmidt College of Medicine, is acutely aware that many doctors steer students away from the business. His institution counters this tendency by ensuring primary care specialists have a louder voice among faculty and administrators.

“Students hear a lot about primary care from us, both in medical education and student affairs,” he says.

Primary care’s position toward the bottom of the salary scale has also been a deterrent for students facing ever-higher debt loads. The industry has begun to respond to this situation recently, however, with a trend toward rising starting salaries and higher compensation in general among primary care physicians.

Source: fiercehealthcare.com

SINGAPORE: The Ministry of Health (MOH) will launch a call for general practitioners (GPs) to join its Primary Care Networks (PCN) scheme on Apr 1.

Participating GPs will be able to tap on funding and administrative support to implement team-based care to better monitor and manage their patients’ healthcare needs, the ministry said in its press release on Wednesday (Mar 29).

Under the scheme, MOH will provide funding and administrative support to GPs to form virtual networks and deliver care as multi-disciplinary teams which include doctors, nurses and other supporting staff. This support includes funding for nurse counsellors and care coordinators, as well as support to establish chronic disease registries, it added.

The GPs who are part of the scheme will have to follow stipulated clinical requirements, such as establishing a chronic disease registry for more effective monitoring and early intervention of patients’ clinical and care outcomes, according to the press release.

“Patients will be able to access nurse counsellors for individualised advice to manage their conditions, including lifestyle and dietary modifications,” MOH said. “There will be closer monitoring of their chronic conditions for earlier intervention, and more convenient access to services such as diabetic foot and eye screening.”

The application call will close on May 31 this year, the ministry said. 

- CNA/kk

Source: channelnewsasia.com

For universal primary care

The House and Senate Health Care committees are now considering legislation proposing publicly funded primary care for all Vermonters (H.248 and S.53). The League of Women Voters strongly supports these bills.

The League of Women Voters does not jump on bandwagons.

We study an issue and come to member consensus before reaching an advocacy position. In 1990 the League of Women Voters U.S. used that process before adopting a position in favor of a national single-payer health care.

While continuing to pursue that goal, the league recognized that the states could provide models for the nation. The League of Women Voters VT conducted its own study, adopted in 2005, to reach a position more amenable to state-level implementation. That position is the basis for the League’s strong support for H.248 and S.53.

Most health care is primary care. Accessible, publicly funded health care will save money. When patients do not delay a doctor visit because of cost, more complex, expensive care is avoided. Include mental health care and substance abuse counseling to primary care, and even more problems are headed off. Publicly funded primary care is an investment in public health.

H.248 and S.53 do not request funds at this time. Rather, the legislation asks that the Joint Fiscal Office present funding options for consideration. Please contact your legislators and ask them to support universal primary care. Let the Joint Fiscal Office provide a way to make this basic human need a reality for Vermonters in these uncertain times.

CATHERINE RADER

East Montpelier

Source: burlingtonfreepress.com

SLEMAN — Berdasarkan data yang dimilik Dinas Kesehatan (Dinkes) Sleman, tercatat angka penderita Tuberkulosis (TB) di Sleman mencapai ratusan yang terdeteksi.

Kepala Dinas Kesehatan (Dinkes) Kabupaten Sleman, Nurulhayah mengatakan berdasarkan survei 2013 lalu ada 217 penderita TB pada setiap 100.000 penduduk. Sementara di Sleman, pada 2016 lalu baru tercatat sebanyak 347 penderita TB.

“Baru tercatat sebanyak 14,80 persen, artinya masih ada 85 persen penderita TB yang harus kami temukan,” kata dia saat dijumpai pada peringatan hari TB sedunia yang jatuh 24 Maret lalu di Pondok Pesantren Bina Umat Moyudan, Rabu (29/3/2017).

Nurulhayah menyampaikan hal tersebut menjadi PR bagi pemerintah kabupaten untuk memberantas habis penyakit menular TB. Selama ini pemerintah pun menghadapi kendala dalam menemukan penderita penyakit tersebut. Hal ini disebabkan masyarakat dinilai kurang mampu untuk menyadari pentingnya pengetahuan terhadap TB. Masyarakat yang tidak paham pengetahuan terkait TB akan sulit untuk berobat apabila terjangkit, sedangkan bagi masyarakat yang tau dirinya terjangkit TB ada stigma negatif yang beredar di masyarakat.

Stigma negatif yang berkembang tersebut yakni rasa takut disingkirkan, dikucilkan dari lingkungan masyarakat. Sehingga, penderita merasa malu dan enggan untuk memeriksakan diri ke petugas pelayanan kesehatan.

“Hal ini kalau dibiarkan maka penderita tidak akan sembuh, penyakitnya justru semakin terus menular,” ujarnya.

Sumber: solopos.com