Presentation on theme: "Does the GP make a difference in palliative care? Birgit Aabom General practitioner, ph.d."— Presentation transcript:
Does the GP make a difference in palliative care? Birgit Aabom General practitioner, ph.d.
Rate of GP home visits (per month) Adjusted odds ratio (95%CI) for dying in hospital (N=4386) 0 1.00 0.1 - 0.5 0.14 (0.09 to 0.21) 0.6 - 1 0.11 (0.07 to 0.17) 1-2 0.07 (0.05 to 1.00) 2-4 0.06 (0.04 to 0.08) >4 0.05 (0.03 to 0.08) Aabom B, Kragstrup J, Vondeling H, Bakketeig LS, Støvring H. Population-based study of place of death of patients with cancer: implications for GPs. Br J Gen Pract 2005; 55:684-9.
GP Hospital staff Palliative team / Hospice Death GP
“…they are good at that….. raising your spirits…….both the doctors and the nurses…. I would say you could use them as role models. They are incredibly careful and fantastic at keeping up ones spirit.” ( B12, 1. interview ) “…yes, they phone you and ask how you are feeling, tell you that your blood tests are OK. I have great respect for this. I think they do it very well…” ( B 1, 1. interview ) “When I come to the centre….. it is as if they have been waiting for me to come…” ( A 6, 1. interview ) Aabom B, Pfeiffer P. Why are some patients in treatment for advanced cancer reluctant to consult their GP? Scand J Prim Health Care 2009; 27: 58-62.
”..Not used my GP, he does not know the treatments I receive” ( Patient B4, 2. interview ) “My GP is not up-to-date” ( Patient B5, 1. interview )
“A lot of times I need to talk. Then I decide on my way to the hospital that I want to talk with one of the staff- it might be something physical or something psychological- but the problem is, that I share room with others, the room is filled with people and I don’t want to share my problems with the others in the ward, so I don’t say anything” (Patient A6, 3. interview)
“But it is possible that the talk I miss with the hospital doctors that I could get that from my GP. I could pay him a visit. Then he could discuss my case with the oncologist, take a few days to make himself acquainted with the situation, maybe go into details with the hospital doctors about specific questions I have. He could then follow my case and support me, that` s some of the thoughts I have had.” (Patient B1, 2. interview)
Yes, the GP makes a difference n GP home visit important for cancer patients n However, GP loosing contact to late-stage cancer patients – (also) due to patient factors n Patients had increasing unmet psychosocial needs as the disease progressed Conclusion:
Table 8. Risk of dying in hospital in relation to GP home visits (+/- GP) among patients with and without a terminal declaration (+/- TD) + TD- TD GP home visits per week NOR (95%CI)Hospital death % NOR (95% CI)Hospital death % + GP visit (0/1variable) 7740.18 (0.11-0.29)3912510.08 (0.05-0.13)66 0160178591192 0.1-0.191530.28 (0.17-0.47)771780.14 (0.09-0.20)89 0.2-0.391160.11 (0.06-0.20)482110.14 (0.09-0.21)51 0.4-0.591550.08 (0.04-0.13)301420.07 (0.05-0.11)34 0.6-1.491550.09 (0.06-0.16)261090.09 (0.06-0.15)43 ≥1.5310.07 (0.03-0.18)12200.10 (0.04-0.27)40