To increase access of palliative care, turn to primary care
Editor's Note: which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Glen Stream, MD, FAAFP, MBI, a family physician practicing in La Quinta, California, who is also past president of the American Academy of Family Physicians. He serves as the president and board chair of Family Medicine for America’s Health. The views expressed in these blogs are those of their respective contributors and do not represent the views of or UBM Medica.
America is facing an epidemic of chronic illness. Today, half of all adults in the United States have a chronic disease like chronic lung disease, cardiovascular disease or cancer.
Further reading: ACP urges collaborative action to put patients before paperwork
By 2030, a projected 70% of those over 65 will have at least one such disease. Chronic illness also places a heavy financial burden on the nation’s health system, accounting for 86% of all healthcare spending in 2010.
A recent article in The Journal of the American Board of Family Medicine (JABFM) noted that two segments of the health care system—palliative care delivered by specialists and primary care—are known to treat these seriously ill people while meeting the “triple aim”: improving the patient’s care experience, improving the health of those with chronic illness and reducing per capita healthcare costs.
In its 2014 report, Dying in America, the Institute of Medicine recommended that all people with advanced serious illness should have access to palliative care—care that provides patients with relief “from the symptoms, pain and stress of a serious illness, whatever the diagnosis.”
The reality, though, is that there is a severe shortage of palliative care specialists and their services are often only available to those in the hospital or in hospice. As the population ages and more Americans begin to suffer from chronic illnesses, the gap between patient need and the availability of palliative care will only widen.
Enter primary care—doctors whose long-term relationships with their patients best position them to provide basic palliative care to them.
As I (Nowels) and my co-authors observe in our JABFM article, “the need for all providers to deliver basic palliative care has emerged as patients’ needs outstrip the capacity of specialty palliative care,” many patients with complex illnesses have unmet needs and are seen in primary care more than other settings.