Palliative care adapted to specific high-risk patients' needs can reduce emergency room visits, improve overall care and drive down healthcare costs, but the current policy and practice framework presents numerous obstacles to its implementation, according to a new report from the Journal of Palliative Medicine.
"Much of the intent of these programs is to overcome both the balkanized health system--hospital, outpatient practice, nursing home, assisted living, hospice--and the disconnect between medical disciplines--primary care providers, hospitalists, cardiologists, oncologists, surgeons, and other specialists--that can frustrate and confound patients," wrote Kathleen Unroe, M.D., of the Indiana University, and Diane E. Meier, M.D., of the Center to Advance Palliative Care.
There are two major obstacles to broader implementation of palliative care, according to a blog post from the New York Times. Firstly, it's typically--and incorrectly--equated with hospice/end-of-life care, Meier said. "Hospice is a form of palliative care for people who are dying, but palliative care is not about dying," she told the Times. "It's about living as well as you can for as long as you can."
Secondly, there are not enough doctors trained in palliative care, according to the Times. It was only declared a medical specialty six years ago, and only a handful of medical students and residents receive appropriate training, according to Meier. "Most doctors in practice today were trained more than 20 years ago, when palliative care didn't exist," she said.
The report addresses several necessary measures to better implement patient-centered palliative care, including:
"Scaling up" those palliative care models that have proven successful;
Taking advantage of mechanisms furthered by healthcare reform, such as accountable care organizations;
Improving quality measures, which, according to the authors, tend to be narrow and discount patients with multiple chronic conditions and impairments;
Addressing workforce needs, both in terms of the current shortage of providers with geriatric training (there is only one palliative care doctor per 1,300 patients with a serious condition) and incorporating geriatric and palliative care principles into other providers' training; and
Determining the future of hospice care.
A March editorial in JAMA Surgery endorsed expansion of palliative care, saying it would drive down costs while improving patient outcomes and satisfaction, FierceHealthcare previously reported.