Family Physicians with Certificates of Added Competence in Palliative Care Contribute to Comprehensive Care in Their Communities: A Qualitative Descriptive Study

Howard, Michelle; Fikree, Shireen; Allice, Ilana; Farag, Alexandra; Siu, Henry; Baker, Alison; Pereira, José; Hosseini, Shera; Grierson, Lawrence; Vanstone, Meredith

doi:10.1089/pmr.2022.0057

Cited by 3 publications

(7 citation statements)

References 17 publications

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“…Moreover, the studies began to reveal that the Shared Care model was relatively uncommon and difficult to apply and could be represented adequately by one category. 36 , 37 …”

Section: Resultsmentioning

confidence: 99%

“…The Shared Care model, although meant to harness the respective strengths of each, may be more challenging to operationalize in palliative care where the lines that separate responsibilities may be difficult to draw, especially in end-of-life care. 36 , 37 Lack of clarity of roles and suboptimal communication between providers risks optimal patient care. Some regulatory and professional bodies therefore recommend that there be only one MRP at any given time, and that any changes in responsibility be mutually agreed upon and clearly communicated and documented.…”

Section: Resultsmentioning

confidence: 99%

“…In a Canadian study by Howard et al, for example, the remuneration method of the physicians influenced the model provided; a fee for service model where a physician is paid through clinical billings to government for clinical services rendered appeared to drive a Takeover model. 37 …”

Section: Discussionmentioning

confidence: 99%

“…In a separate study, researchers studying the impact of palliative care physicians with added certificates of competency in palliative care across several community sites in Canada, confirmed practice patterns that aligned with the three models ( Consultation , Shared Care, and Takeover ). 37 Funding models and other structures were perceived as incentivizing the Takeover model.…”

Section: Methodsmentioning

confidence: 99%

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Are We Consulting, Sharing Care, or Taking Over? A Conceptual Framework

Pereira,

Klinger,

Seow

et al. 2024

Palliative Medicine Reports

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Background: Primary- and specialist-level palliative care services are needed. They should work collaboratively and synergistically. Although several service models have been described, these remain open to different interpretations and deployment. Aim: This article describes a conceptual framework, the Consultation-Shared Care-Takeover (C-S-T) Framework, its evolution and its applications. Design: An iterative process informed the development of the Framework. This included a symposium, literature searches, results from three studies, and real-life applications. Results: The C-S-T Framework represents a spectrum anchored by the Consultation model at one end, the Takeover model at the other end, and the Shared Care model in the center. Indicators, divided into five domains, help differentiate one model from the other. The domains are (1) Scope (What aspects of care are addressed by the palliative care clinician?); (2) Prescriber (Who prescribes the treatments?); (3) Communication (What communication occurs between the palliative care clinician and the patient's attending clinician?); (4) Follow-up (Who provides the follow-up visits and what is their frequency?); and (5) Most responsible practitioner (MRP) (Who is identified as MRP?). Each model demonstrates strengths, limitations, uses, and roles. Conclusions: The C-S-T Framework can be used to better describe, understand, assess, and monitor models being used by specialist palliative care teams in their interactions with primary care providers and other specialist services. Large studies are needed to test the application of the Framework on a broader scale in health care systems.

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“…Moreover, the studies began to reveal that the Shared Care model was relatively uncommon and difficult to apply and could be represented adequately by one category. 36 , 37 …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Are We Consulting, Sharing Care, or Taking Over? A Conceptual Framework

Pereira,

Klinger,

Seow

et al. 2024

Palliative Medicine Reports

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“…Notably, our findings also identified that CAC holders interact with other practitioners via one of four collaborative models, each of which brings distinct benefits to comprehensive care: an enhanced scope of services model, a shared-care model, a family physician-aligned transfer of care model, and a specialist-aligned transfer of care model. 7 Upon completion of the initial multiple case study, we engaged in focused analyses of the data in order to develop descriptions of what motivates family physicians and family medicine residents to pursue a CAC 16 and unique experiences within certain disciplines including Sports and Exercise Medicine, 17 Emergency Medicine, 18 Palliative Care 19 and Care of the Elderly. 20 This work highlighted that the individual's perceptions of community need and their desire to build a practice scope that matches their personal and professional preferences intersect to promote (or dissuade) pursuit of the credential.…”

Section: Introductionmentioning

confidence: 99%

The Certificate of Added Competence credentialling program in family medicine: a descriptive survey of the family physician perspective of enhanced skill practices in Canada

Elma,

Vanstone,

Allice

et al. 2023

Can. Med. Ed. J

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Introduction: The College of Family Physicians of Canada (CFPC) offers the Certificate of Added Competence (CAC) program to designate a family physician with enhanced skills. In 2015, the College expanded its program to introduce enhanced certification in four new domains: Palliative Care, Care of the Elderly, Sports and Exercise Medicine, and Family Practice Anesthesia. In this study, we elicited perceptions from Canadian family physicians with and without the CAC on practice impacts associated with the program. Methods: Active family physicians in Canada with and without CACs were surveyed between November 2019 to January 2020. Descriptive statistics were generated to describe the perceptions of family physicians regarding the CAC program and its impacts on practice. Results: Respondents agreed with several benefits of the program including enhancing the capacity to deliver comprehensive care, alleviating the burden of patient travel by increasing the availability of care in rural and remote communities, and providing opportunities to engage in various collaborative care models and new leadership roles. All respondents perceived CAC holders to pursue the certificate to meet both professional interests and community needs. Conclusions: There is a need for strong and continued investment in systemic practice improvements that incentivize the delivery of comprehensive family medicine practice.

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