Report says 1-in-100 GP consultations involve palliative care
Given the political debate around end-of-life decision making and the need for more effective and accessible palliative care the AIHW’s report Palliative care services in Australia could not have been better timed.
Before interrogating the stats let’s take a look at the terminology.
With typical verbosity the World Health Organization is quoted as calling palliative care ‘an approach that improves the quality of life of patients (adults and children) and their families who are facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.’
In Australia, and many other parts of the world, the demand for palliative care services is increasing due to the ageing of the population and the increases in the prevalence of cancer and other chronic diseases that accompany ageing, the report notes.
‘Historically, it was assumed that palliative care would commence only once all treatment aimed at ‘curing’ people had finished or only when a person was dying. Now, it is well-accepted that there is benefit in providing palliative care in association with disease-modifying therapies that aim to prolong life.
‘It is also recognised that many people with life-limiting illnesses are not ‘cured’, but continue to live with these illnesses for many years.’
It adds, ‘A distinction is commonly made between care provided in hospitals (including hospices or dedicated palliative care wards) and care provided in the community (such as in the patient’s home or in residential aged care facilities).
‘Specialist palliative care services are comprised of multidisciplinary teams with specialised skills, competencies, experience and training to deliver care to people where the palliative needs are complex and persistent (PCA 2018). Specialist palliative care services operate from a variety of settings, including specialist inpatient consulting services, specialist inpatient settings, hospices and community-based specialist services (DoH 2019).’
The AIHW report, online and updated twice yearly, notes that data collection has been impeded by the discontinuation of the BEACH survey (1998 to 2016), and this presents a challenge for future reporting on the pivotal role that general practitioners have in delivering high quality palliative care.
GPs, it noted, ‘play an important role in palliative care as well as the health-care system more broadly’.
For example, the last BEACH indicated that about 1-in-1000 GP encounters were palliative care-related. The AIHW, on the other hand, cites a Department of Health study showing a frequency ten times higher – [it was] ‘estimated that palliative care consultations account for about 1 in every 100 GP consultations (1%) (Department of Health 2017).
‘The differences in the results between this survey and the BEACH survey are likely to be due to different methodologies including aspects such as the composition of the populations of GPs who responded to each survey and how a palliative care encounter or consultation was defined,’ the report notes.
It goes on to say ‘there is no nationally consistent, routinely collected primary healthcare data collection that enables reporting on the provision of palliative care by GPs.
‘Furthermore, while the Medicare Benefits Schedule (MBS) includes specific items for palliative medicine specialist services (delivered by palliative medicine specialists) for which it will reimburse a proportion of the MBS fee… there are no palliative care-specific items that can be used by GPs or other medical specialists who may be providing palliative care (such as oncologists).
‘It is therefore likely that GPs use other MBS items, for example, those for chronic disease management and home visit items, when providing patients with palliative care.
‘Consequently, the extent of palliative care-related services delivered by GPs cannot be established from existing Medicare data.’
This is not to downplay the value of the data, which reveals (BEACH figure) that about 9 in 10 palliative care GP encounters were with people aged 65 and over. Females accounted for 53.0 per cent of this patient cohort. Palliative care-related encounters with Indigenous Australians were 1.3% of the total, less than half the proportion of the general population which is Indigenous.
Some 53.6 percent of palliative care hospitalisations and 54.2 percent of other end-of-life care hospitalisations were for people aged 75 and over.
Other findings from the survey were that GPs’ understanding of what constitutes palliative care and end of life care varies widely and that differing palliative care settings have very different requirements in terms of best practice. The report on the survey also provided a range of recommendations, including better defining the role of GPs in palliative care, promoting a better understanding of the clinical triggers for commencing palliative care, the development of local directories to enable GPs to access palliative care resources and better communication and integration with other parts of the health system including encouraging referrals to specialist palliative care teams or GP experts.
AIHW says it is currently working with stakeholders to establish a consistent data collection on palliative care activity in general practice, to better inform the community and enable decision-makers at all levels to monitor GPs’ provision of high quality palliative care to Australians that meets their needs.