Engaging Primary Care Physicians to Refer Patients to Home-Based Palliative Is Challenging and Complicated

Abstract

Background: Before the Affordable Care Act (ACA), the financing landscape for fee-for-service health care lacked broad structure and incentives to provide palliative care outside hospitals. Since the ACA, several payers have taken the opportunity to offer home-based palliative care (HBPC) to their members. Objective: To evaluate the impact of outreach efforts by a physician champion among a cohort of primary care physicians (PCPs) to introduce a new HBPC program and benefit, obtain buy-in, and motivate referrals for Blue Shield patients. Design: Secondary qualitative analysis of detailed field notes from a HBPC physician champion from in-person meetings with a cohort of PCPs and their office staff. Subjects: PCPs were from a physicians group in northern California that met with the physician champion during a 12-month study period. Results: During the 12-month study period, the physician champion met with clinicians at 27 distinct primary care offices. Qualitative analyses revealed three independent themes relating to receptivity and perception of the new HBPC program: (1) physician-level factors (overburdened, lack of palliative care knowledge, misconceptions around palliative care, and patient control), (2) practice-level factors (practice structure and role/integration of advance practice providers), and (3) first impression of the HBPC program (receptivity, ''dirty data,'' and communication). Conclusion: Results hold important implications for practice and new approaches to engaging PCPs in HBPC, obtaining buy-in, and generating patient referrals. PCPs need better support in caring for patients with serious illness and HBPC can likely fill that role if PCPs are willing to refer and HBPC programs adapt.

Engaging Family Physicians in the Provision of Palliative and End-of-Life Care: Can We Do Better?

“…Upon completion of this exploratory study and as work was underway on this report, additional publications about the theme became available complementing our findings. 10 , 19 , 26 , 27 In a recent article in The Ottawa Citizen , Booke and Stajduhar stated, “As Canadians, we now have a legal right to medical assistance in dying. It's time to demand that we should have an equal right to medical assistance in living.” 28 We would argue that our Canadian healthcare system can better support medical assistance in living by ensuring that FPs have access to education that includes available PEoLC tools and resources, how and why to access those resources and focuses on interprofessional communication, and by providing fair compensation that addresses the challenges of conducting home visits.…”

“…Upon completion of this exploratory study and as work was underway on this report, additional publications about the theme became available complementing our findings. 10,19,26,27 In a recent article in The Ottawa Citizen, Booke and Stajduhar stated, ''As Canadians, we now have a legal right to medical assistance in dying. It's time to demand that we should have an equal right to medical assistance in living.''…”

“…13 Few Canadian studies identified barriers to the involvement of PCPs in PEoLC, including gaps in knowledge (about the healthcare system and PEoLC) and the time required for home visits. [14][15][16][17][18] In the United States, Kogan et al, 19 in the inaugural issue of Palliative Medicine Reports, pointed out that engaging PCPs to refer patients to a home-based palliative care service in northern California is complicated. They refer to lack of time, lack of palliative care health literacy, and the desire to retain oversight of their patient's care as important barriers.…”

“You cannot stop talking about palliative care:” Perspectives and Learnings from Providers on Communicating about Home-based Palliative Care to Patients and Physicians

“…Although HBPC programs have operated in the U.S. as service programs independent from hospice for more than a decade, there remains enormous confusion about palliative care, among both healthcare providers 4 and patients and family members. 5 Studies have documented the limited knowledge consumers have of palliative care 6-9 as well as their conflation of palliative care with hospice. 10,11 Lack of healthcare service knowledge has been found to prevent receipt of healthcare services.…”

“…The purpose of this study was to elicit successful practices in how to communicate about HBPC to both healthcare providers and patients/caregivers. Given the wealth of challenges promoting uptake of HBPC services, 4,7,8,17 understanding effective communication practices is critical.…”