EAPC Atlas of Palliative Care in Europe 2019

Chapter 9. Integration of Palliative
Care at the Primary Care level
EUROPEAN CONTEXT
B
TECHNICAL DATA
ON THE 2019 EAPC
SURVEY ON PALLIATIVE
CARE AT THE PRIMARY
CARE LEVEL
Population: 54 countries of the
Europe WHO region and Lichtenstein.
Survey Details
Areas explored: 5 main health
indicators: identification of PC
patients at the primary care level
and months before death cared for,
incentives to the identification of PC
patients, official policy documents
on primary PC (laws or strategies/
plans/policies), primary palliative
care education, and the denomination
of doctors at the primary
care level.
Questionnaire: on-line survey, 10
questions, answered in (average)
16 minutes.
Participants: 52 national experts on
Primary Palliative Care and PC.
Profile of experts (affiliation):
22 PC experts, 15 primary care
experts, 11 academicians, and
4 NGOs or Oncology Centres´experts.
Coverage: 34/54 countries
(63%): with one respondent
22/34 (65%) countries and with
two or more respondents 12/34
(35%) countries.
Data collection: 12/2018 to
3/2019 (4 months).
Project Management: ATLANTES
Research Group, Institute for Culture
and Society, University of Navarra,
Pamplona (Navarra), Spain .
Scientific Advice: Scott Murray
(United Kingdom), Sébastien Moine
(France).
Promotor: European Association
for Palliative Care (EAPC).
PALLIATIVE care provision in Europe
ONLY reaches a small proportion
of the population and varies
GREATLY depending on the disease,
PATIENT’s stage of the illness, and
geographical context.
Part of this variation in coverage
could be ameliorated by partnering
with primary care providers,
who often already play a major role
in providing palliative care. Partnership with
primary care providers could improve early
identification of patients eligible for palliative
care, strengthen continuity among various levels
of care, and provide greater access to person-centred
care.
The European Association for Palliative Care
Primary Care Reference Group and the World
Health Organisation share the conviction that
a coordinated primary care and public health
approach is necessary to gain universal coverage
and early access to palliative care in the
community (1, 2, 3, 4).
Identifying PC patients
at the primary level
Although we know that more patients receive
palliative care by primary care staff than by
palliative care specialists in hospices and the
community, only 12 countries reported primary
care teams identifying more than 20%
of their patients for palliative care before they
died (across all diseases). Three countries (Finland,
Poland, and The Netherlands) report the
highest proportions of palliative care needs
identified at the primary care level, ranging
from 61 to 80%.
The average number of months before death
that patients are cared for by primary care professionals
ranges from one week to one month
(11/34 countries, 32%), and one month to six
months (12/34 countries, 35%). Germany and
Switzerland report better figures that range from
six months to one year or over.
Eduardo Garralda, Scott Murray, Sébastien Moine.
Some European countries promote the identification
of palliative care need through incentives
for primary health professionals. However, there
is no clear correlation between incentives and
proportion of patients in need of palliative care
identified at the primary care level. In fact, up
to 10/34 countries (29%) have at least some
sort of incentive system in the form of economic
compensation (the most common), academic/
curricular awards, or time off, such as free days,
extra hours of leave, or early leaves.
Official documents regulating
Primary PC provision
Palliative care is included in primary care official
documents: 31/34 European countries (92%)
at least specifically mention palliative care provision
within these documents. Specifically, 20
countries have a national or regional law (38%)
and 22 report a national or regional plan/strategy/policy
specifically mentioning PC provision
at the primary care level. Other types of official
documents include clinical guidelines, orders
of the Ministry of Health (Kyrgyzstan), national
quality frameworks, and position papers on
palliative care (The Netherlands).
Primary PC education
in Medical Schools
Inclusion of palliative care at the primary care
level in undergraduate institutions is documented
in 21 countries (62%). However, this varies
greatly from country-to-country. For example,
12 countries teach palliative care at the primary
care level in all medical schools, two countries in
half of medical schools, and seven countries in
less than a 40% of their medical schools. Variations
are even bigger if we look at the number of
dedicated hours, medical schools where these
components are mandatory, and when taking
into account a lack of official, up-to-date information.
Generally, residency programs for family
physicians incorporates some palliative care
training in 22 countries (65%), and 17 countries
(50%) report having these components included
in the training for general physicians (GPs).
EAPC Atlas of Palliative Care in Europe
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