Author: Dr Shrikant Atreya, M.D., Fellowship in Palliative Medicine, PhD scholar
Consultant, Pain and Palliative Medicine, Department of Palliative Care and Psycho-Oncology,Tata Medical Centre, Kolkata
World Family Medicine Day, 19th May
Globally, the World Family Medicine day, is a day ear marked to celebrate and acknowledge the role and contribution of family doctors and primary care teams in healthcare systems around the world. It is these doctors and teams who essentially take healthcare service provision to every nook and corner within a country.
We cannot further emphasise the importance of integrating these family doctors and the primary healthcare teams in the implementation of a country’s national healthcare programs as a step towards ensuring Universal Coverage of Healthcare.
We bring to you Dr Shrikant Atreya’s outlook, as he shares his perspectives on ‘The Role of a General Practitioner / Family Physician in delivering community-based palliative care services’.
India has seen a positive dramatic move towards the better acceptance of palliative care, with several institutions, especially oncology centres integrating palliative care into other clinical disciplines. Although it is a well-known fact that palliative care assures the quality of life of patients and their families experiencing chronic, life-threatening illnesses, this is however, incommensurate with the expanse of the service. A large proportion of this specialised service is unfortunately concentrated in district or sub-district hospitals, which caters to only a mere 10% of the needy population, and thereby leaving a bulk of the population in lurk for these services. The overwhelming demand for palliative care can only be met by empowering the community through a primary palliative care model. A Primary palliative care model is a collaborative care model that brings together the general practitioner from within the community with specialist palliative care services. The general practitioner coordinates and leads the care in the community and also ensures a seamless transition of care in the community.
The General Practitioner forms the core of the patient and family care, and act as an essential bridge between a patient in the community and the specialist palliative care services. The ambit of services provided by a general practitioner ranges from screening of disease, delivering bad news, offering family counselling, providing guidance in treatment decision-making, delivering comprehensive care by networking with other general practitioners, specialist palliative care services, community health/social workers and volunteers, and providing domiciliary palliative care. An empowered general practitioner is an important fulcrum to ensure continuity of palliative care services for patients in the community. The general practitioner will also affirm that quality palliative care is provided to the patient and their family at their doorstep.
A survey conducted in 2019 explored the various facilitators and barriers as perceived by general physicians while providing palliative care within the community. Although general practitioners recognised palliative care as an essential component of their routine practice, they did not feel comfortable and confident in providing this care. A few of the challenges in care provision included personal barriers due to a lack of competence and emotional framework to care for the terminally ill patients, the lack of interpersonal communication and collaboration between specialists and generalists, and an unstructured health care delivery system with a poor referral system between the specialists and the generalists.
In order to address the dire need for community-based palliative care in the country, a taskforce was constituted in the year 2017. The taskforce was represented by 15 National and International professionals from various medical disciplines such as palliative care, public health, family medicine, geriatric medicine and distance education. Inspired by the 2019 survey, the taskforce aimed at developing standards for primary palliative care education and community based palliative care provision in the country. Efforts are underway to incorporate primary palliative care education into the postgraduate curriculum for family medicine and general practice.
The COVID 19 pandemic has brought along with it an unprecedented change in the healthcare delivery system, but at the same time, also sown the seeds for further learning and strengthening of palliative care delivery within the community. Considering the limitations of physical consultations, there has been a major adoption of tele-palliative care services across the country. A triage model for palliative care consultation (Table 1) may act as in important guide to remotely care for patients with palliative care needs in the midst of the pandemic situation. The general practitioner from within the community is therefore provided with an opportunity to act as an interface between the patients in the community and the palliative care specialists in the hospital. This model has been tested over time and has proveen to be beneficial for those patients seeking remote services.
Table 1: Triage model for palliative care consultation