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 Table of Contents 
LETTER TO EDITOR
Year : 2019  |  Volume : 8  |  Issue : 9  |  Page : 3074-3075  

Integrating palliative care with primary care: A synergistic mix


Department of Pharmacology, AIIMS, Bhopal, Madhya Pradesh, India

Date of Submission08-Jul-2019
Date of Decision22-Aug-2019
Date of Acceptance28-Aug-2019
Date of Web Publication30-Sep-2019

Correspondence Address:
Dr. Avik Ray
Department of Pharmacology, 3rd Floor, Medical College Building, All India Institute of Medical Sciences Bhopal, Saket Nagar, Bhopal, Madhya Pradesh - 462 020
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_519_19

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How to cite this article:
Ray A, Najmi A, Sadasivam B. Integrating palliative care with primary care: A synergistic mix. J Family Med Prim Care 2019;8:3074-5

How to cite this URL:
Ray A, Najmi A, Sadasivam B. Integrating palliative care with primary care: A synergistic mix. J Family Med Prim Care [serial online] 2019 [cited 2019 Oct 19];8:3074-5. Available from: http://www.jfmpc.com/text.asp?2019/8/9/3074/268040



Sir,

In reference to the editorial titled “A primary care–based patient centric palliative care model” by Raina et al.,[1] we would like to supplement the topic with a few more information and our comments.

Adult patients suffering from advanced and serious illnesses such as late-stage cancer, advanced heart or renal failure and neurodegenerative diseases such as moderate to severe Parkinson's disease or Alzheimer's disease [2] experience quite a high burden of physical symptoms, limitation in normal functioning, and declining quality of life (QoL) over the course of the illness.[3] Taking proper care of these patients can often be a daunting task, both physically and emotionally, for the families and the loved ones. The scope and extent of the challenges associated with managing advanced and life-limiting illnesses is only expected to increase given the growing proportion of the Indian population which is aging and is likely to have multiple co-morbid health conditions and the projected shortage of primary care physicians to care for them.

Since palliative care usually involves multiple physicians, including both primary and specialty care providers and across multiple healthcare settings, communication and coordination among various clinicians as well as communication and decision making between various clinicians, patients, and their caregivers becomes important to achieve the primary goal of primary care: addressing supportive care needs and improving the quality of life of patients and their caregivers.

Care coordination is a major priority for critically ill patients, who transition between inpatient, outpatient, and emergency care. In such a scenario, primary care-driven patient-centered medical homes (PCMHs)[4] can be an important tool in our country to proactively manage population of such seriously ill patients and co-ordinate care across the healthcare delivery settings. This way, the approach of primary care-based patient centric palliative care as mentioned in the editorial [1] can truly be realized. Such a delivery system may offer an ideal setting for early longitudinal palliative care.

One of the innovative models for delivery of palliative care is nurse practitioner-led Primary Palliative Care Clinic (PPCC) which is established at the Harborview Medical Center in Seattle, Washington.[5] They receive referrals from various healthcare service providers and nursing facilities to provide primary care for patients with critical illnesses. Primary care physicians co-manage and co-ordinate care for such patients. This is again something which we can think of incorporating in our existing healthcare delivery system.

Palliative care, by definition, is patient centered. It aims to deliver patient-centered care by formulating and implementing care plans consistent with patient and caregiver goals and preferences. Integration of palliative care into primary healthcare setting improves QoL for seriously ill patients. Waiting until the end stage of a disease before referring for palliative care means that the patients miss out on improving their QoL throughout their treatment.[6]

The suggested models not only depends on the familiarity of the primary care physicians with palliative care but also rests on whether the primary care team has members with palliative care expertise. These are early steps towards the necessary evolution of patient-centered care for critically ill patients. Comparative effectiveness research (CER) studies to compare different models and approaches to deliver palliative care to patients with advanced illnesses and their caregivers should be performed to come up with guidelines for primary care-based patient centric palliative care in India.

Incorporation of such a sustainable model integrating palliative care with primary care into the healthcare delivery system should be preceded by a change in the mindset and the way of thinking of the physicians besides changes in the current MBBS curriculum of India. Knowledge about primary care and rational usage of the commonly prescribed drugs in palliative care play important roles in managing patients and delivering palliative care in a primary care setting. Hence, imparting sufficient understanding of the palliative care techniques and rational prescribing to medical students so that they can modify treatment regimen if needed, add or delete drugs based on needs, deal with complex drug interactions, adverse drug events, and patient concordance [7] while providing palliative care is of utmost importance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Raina SK, Kumar R, Gupta RK. A primary care–based patient centric palliative care model. J Family Med Prim Care 2019;8:1519-22.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
National Consensus Project for Quality Palliative Care (NCP). Clinical Practice Guidelines for Quality Palliative Care. 3rd ed.; 2013. Available from:https://www.nationalcoalitionhpc.org/wp-content/uploads/2017/04/NCP_Clinical_Practice_Guidelines_3rd_Edition.pdf. [Last accessed on 2019 Jun 25].  Back to cited text no. 2
    
3.
Bauman JR, Temel JS. The integration of early palliative care with oncology care: The time has come for a new tradition. J Natl Compr Canc Netw 2014;12:1763-71.  Back to cited text no. 3
    
4.
National Committee for Quality Assurance. Patient-Centered Medical Home (PCMH). Available from: https://www.ncqa.org/programs/health-care-providers-practices/patient-centered-medical-home-pcmh/. [Last accessed on 2019 Jun 25].  Back to cited text no. 4
    
5.
Owens D, Eby K, Burson S, Green M, McGoodwin W, Isaac M. Primary palliative care clinic pilot project demonstrates benefits of a nurse practitioner-directed clinic providing primary and palliative care. J Am Acad Nurse Pract 2012;24:52-8.  Back to cited text no. 5
    
6.
Alshammary SA, Alsuhail A, Duraisamy BP, Alabdullateef SH, Ratnapalan S. Interval between first palliative care consultation and death among patients in a comprehensive cancer center in Saudi Arabia. J Health Spec 2015;3:61-6.  Back to cited text no. 6
  [Full text]  
7.
Atal S, Sadasivam B, Ahmed SN, Ray A. Medication concordance in modern medicine – A critical appraisal from an Indian perspective. J Family Med Prim Care 2019;8:1313-8.  Back to cited text no. 7
[PUBMED]  [Full text]  




 

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