Verbesserung allgemeiner ambulanter Palliativversorgung in Hausarztpraxen – Evaluation der Interventionsstudie ALLPRAX

Zusammenfassung

Hintergrund Trotz eines hohen Bedarfs an allgemeiner ambulanter Palliativversorgung (AAPV) fehlt es an konkreten Lösungsansätzen für eine zielgerichtete Integration in Hausarztpraxen. Ziel dieser Arbeit ist die Evaluation von Maßnahmen zur Verbesserung der AAPV aus Sicht hausärztlicher Praxisteams.

Methoden Qualitative Evaluation der Implementierungsstudie ALLPRAX mit sieben Praxisteams mittels der Normalization Process Theory.

Ergebnisse Bedürfnisse von Palliativpatient*innen und ihren Angehörigen konnten mittels eines palliativmedizinischen Erstassessments und Krisenbogens besser identifiziert werden. Zu ihrer Beratung und Informationen wurde die Bereitstellung von Flyern als hilfreich bewertet. Demgegenüber gelang die Integration von Maßnahmen mit hohem Arbeitsaufwand selten.

Schlussfolgerungen Maßnahmen zur Verbesserung der AAPV sollten leicht integrierbar sein und neben den Bedürfnissen von Palliativpatient*innen gezielt die Belastungen von Angehörigen berücksichtigen.

Abstract

Background Despite a high demand for general outpatient palliative care, there is a lack of practical approaches for a targeted integration in GP practices. The aim of this study is to evaluate measures for improving general outpatient palliative care from the perspective of GP practice teams.

Methods Qualitative evaluation of the implementation study ALLPRAX with seven GP practice teams using the Normalization Process Theory.

Results The needs of patients receiving palliative care and their relatives could be better identified by means of an initial palliative care assessment and crisis questionnaire. The provision of handouts for counselling and information of patients and relatives was evaluated as helpful. In contrast, the integration of measures with a high workload was rarely successful.

Conclusions Measures to improve general outpatient palliative care should be easy to integrate and, in addition to the needs of patients, specifically take the burdens of relatives into account.

Schlüsselwörter

Versorgungsforschung - Palliativversorgung - Hausarztpraxen - Interventionen - Evaluation

Keywords

health care research - palliative care - primary palliative care - general practitioner - evaluation

Publication History

Article published online:
29 October 2021

• Literatur

• 1 Radbruch L, Maier BO, Bausewein C. Ambulante Palliativversorgung. Schmerz 2019; 33: 285-286 DOI: 10.1007/s00482-019-0385-z.
• 2 Murtagh FE, Bausewein C, Verne J. et al. How many people need palliative care? A study developing and comparing methods for population-based estimates. Palliat Med 2014; 28: 49-58 DOI: 10.1177/0269216313489367.
• 3 Kassenärztliche Bundesvereinigung K.d.ö.R. Vereinbarung nach § 87 Abs. 1b SGB V zur besonders qualifizierten und koordinierten palliativ-medizinischen Versorgung. Berlin: 2016. https://www.gkv-spitzenverband.de/media/dokumente/krankenversicherung_1/aerztliche_versorgung/bundesmantelvertrag/bmv_anlagen/BMV-Ae_Anlage_30_Palliativversorgung_2017-01-01.pdf Stand 06.01.2021
• 4 Sozialgesetzbuch V. Spezialisierte Ambulante Palliatvversorgung, in §37 b Sozialgesetzbuch V. 2019 https://www.gesetze-im-internet.de/sgb_5/__37b.html Stand 06.01.2021
• 5 Bausewein C, Voltz R, Radbruch L, Simon S. S3-Leitlinie Palliativmedizin für Patienten mit einer nicht heilbaren Krebserkrankung – Langversion 1.1. Mai 2015 – AWMF-Registernummer: 128/001OL 2015
• 6 Nauck F, Jansky M. Spezialisierte Ambulante Palliativ-Versorgung. Dtsch Med Wochenschr 2018; 143: 558-565 DOI: 10.1055/s-0043-115628.
• 7 Radbruch L, Andersohn F, Walker J. Faktencheck Gesundheit: Palliativversorgung – Modul 3 – Überversorgung kurativ – Unterversorgung palliativ? Analyse ausgewählter Behandlungen am Lebensende. https://www.bertelsmann-stiftung.de/fileadmin/files/BSt/Publikationen/GrauePublikationen/Studie_VV__FCG_Ueber-Unterversorgung-palliativ.pdf Stand: 06.01.2021
• 8 Bundesministerium für Gesundheit. Gesetz zur Verbesserung der Hospiz- und Palliativversorgung in Deutschland (Hospiz- und Palliativgesetz – HPG) vom 1. Dezember 2015. Bundesgesetzblatt 2015; 2114-2119
• 9 Kassenärztliche Bundesvereinigung. Ambulante Palliativmedizin wird ausgebaut – Neue Leistungen im EBM. Praxisnachrichten; 2019 https://www.kbv.de/html/1150_30329.php Stand 06.01.2021
• 10 Mitchell GK. How well do general practitioners deliver palliative care? A systematic review. Palliat Med 2002; 16: 457-464 DOI: 10.1191/0269216302pm573oa.
• 11 Howell D. Comprehensive palliative home care: a need for integrated models of primary and specialist care?. Int J Palliat Nurs 2007; 13: 54-55 DOI: 10.12968/ijpn.2007.13.2.23069.
• 12 Groot MM, Vernooij-Dassen MJ, Verhagen SC. et al. Obstacles to the delivery of primary palliative care as perceived by GPs. Palliat Med 2007; 21: 697-703 DOI: 10.1177/0269216307083384.
• 13 Groot MM, Vernooij-Dassen MJ, Crul BJ. et al. General practitioners (GPs) and palliative care: perceived tasks and barriers in daily practice. Palliat Med 2005; 19: 111-118 DOI: 10.1191/0269216305pm937oa.
• 14 Slort W, Schweitzer BP, Blankenstein AH. et al. Perceived barriers and facilitators for general practitioner-patient communication in palliative care: a systematic review. Palliat Med 2011; 25: 613-629 DOI: 10.1177/0269216310395987.
• 15 Magee C, Koffman J. Out-of-hours palliative care: what are the educational needs and preferences of general practitioners?. BMJ Support Palliat Care 2016; 6: 362-368 DOI: 10.1136/bmjspcare-2014-000764.
• 16 Dahlhaus A, Vanneman N, Guethlin C. et al. German general practitioners’ views on their involvement and role in cancer care: a qualitative study. Fam Pract 2014; 31: 209-214 DOI: 10.1093/fampra/cmt088.
• 17 Gidwani R, Nevedal A, Patel M. et al. The Appropriate Provision of Primary versus Specialist Palliative Care to Cancer Patients: Oncologists’ Perspectives. J Palliat Med 2017; 20: 395-403 DOI: 10.1089/jpm.2016.0399.
• 18 Firn J, Preston N, Walshe C. What are the views of hospital-based generalist palliative care professionals on what facilitates or hinders collaboration with in-patient specialist palliative care teams? A systematically constructed narrative synthesis. Palliat Med 2016; 30: 240-256 DOI: 10.1177/0269216315615483.
• 19 Ewertowski H, Hesse AK, Schneider N. et al. Primary palliative Care in General Practice – study protocol of a three-stage mixed-methods organizational health services research study. BMC Palliat Care 2018; 17: 21 DOI: 10.1186/s12904-018-0276-6.
• 20 Stiel S, Krause O, Berndt CS. et al. Caring for frail older patients in the last phase of life: Challenges for general practitioners in the integration of geriatric and palliative care. Z Gerontol Geriatr 2019; 53: 763-769 DOI: 10.1007/s00391-019-01668-3.
• 21 Ewertowski H, Tetzlaff F, Stiel S. et al. [Primary palliative care provision by general practitioners: Development of strategies to improve structural, legal and financial framework conditions]. Z Evid Fortbild Qual Gesundhwes 2019; 149: 32-39 DOI: 10.1016/j.zefq.2019.12.003.
• 22 Zimansky M, Gerdes A, Schneider N. et al. Maßnahmen zur Verbesserung der allgemeinen ambulanten Palliativversorgung aus Sicht hausärztlicher Praxisteams. Z Palliativmed 2021; 22: 41-46
• 23 May CR, Finch T, Ballini L. et al. Evaluating complex interventions and health technologies using normalization process theory: development of a simplified approach and web-enabled toolkit. BMC Health Serv Res 2011; 11: 245 DOI: 10.1186/1472-6963-11-245.
• 24 Highet G, Crawford D, Murray SA. et al. Development and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT): a mixed-methods study. BMJ Support Palliat Care 2014; 4: 285-290 DOI: 10.1136/bmjspcare-2013-000488.
• 25 Geerligs L, Rankin NM, Shepherd HL. et al. Hospital-based interventions: a systematic review of staff-reported barriers and facilitators to implementation processes. Implement Sci 2018; 13: 36 DOI: 10.1186/s13012-018-0726-9.
• 26 Seckler E, Regauer V, Rotter T. et al. Barriers to and facilitators of the implementation of multi-disciplinary care pathways in primary care: a systematic review. BMC Fam Pract 2020; 21: 113 DOI: 10.1186/s12875-020-01179-w.
• 27 Weldam SW, Lammers JJ, Zwakman M. et al. Nurses’ perspectives of a new individualized nursing care intervention for COPD patients in primary care settings: A mixed method study. Appl Nurs Res 2017; 33: 85-92 DOI: 10.1016/j.apnr.2016.10.010.
• 28 Krug K, Ballhausen RA, Bolter R. et al. Challenges in supporting lay carers of patients at the end of life: results from focus group discussions with primary healthcare providers. BMC Fam Pract 2018; 19: 112 DOI: 10.1186/s12875-018-0816-4.
• 29 Höppner C, Schneemilch M, Lichte T. Pflegende Angehörige und ihre Belastungen in Hausarztpraxen identifizieren – Hindernisse und Empfehlungen. Z Allg Med 2015; 91: 310-313
• 30 Carduff E, Finucane A, Kendall M. et al. Understanding the barriers to identifying carers of people with advanced illness in primary care: triangulating three data sources. BMC Fam Pract 2014; 15: 48 DOI: 10.1186/1471-2296-15-48.