Allgemeine Palliativversorgung in der hausärztlichen Praxis: Entwicklung von Strategien zur Verbesserung struktureller, rechtlicher und finanzieller Rahmenbedingungen

Abstract

IntroductionGeneral practitioners (GPs) make a major contribution to outpatient palliative care (AAPV). In 2013, new fee rates for AAPV were included in the uniform assessment standard, which strengthens the financial framework conditions for outpatient palliative care by GPs. The aim of the ALLPRAX project is to improve the framework conditions for AAPV. This contribution focusses on ideas for changing structural, legal, and financial framework conditions for an optimised AAPV. MethodsIn April 2018, 28 healthcare professionals (10 GPs, 3 medical assistants, 3 hospital doctors, and 12 representatives of the nursing professions) from hospice and palliative care providers in Lower Saxony were invited to participate in nine group discussions at Hannover Medical School. During these group discussions, inhibitory factors for AAPV and possible solutions were discussed. The analysis of the group discussions was carried out using a summarizing content analysis according to Mayring. ResultsIn order to optimise palliative care by GPs in Germany, it is proposed that a) additional palliative care specialists for care coordination and round-the-clock availability for patients and relatives in GP practices should be provided (structural solution), b) nursing staff should be permitted to prescribe aids (legal solution), and c) higher remuneration for medical consultations should be provided (financial solution). These approaches could increase feasibility in day-to-day practice and create incentives for caregivers to provide more high-quality general outpatient palliative care. DiscussionThe described high expenditure in general outpatient palliative care, which is hardly inferior to specialised outpatient palliative care from the caregivers’ point of view, is not reflected accordingly, neither structurally nor financially. ConclusionIn order to optimise general outpatient palliative care, structural, legal and financial framework conditions need to be correspondingly adapted.