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    To increase access of palliative care, turn to primary care


    The California HealthCare Foundation has also recognized the role primary care physicians can play in delivering much-needed palliative care.

    “Both focus on and treat the whole person, not just the disease or health condition,” the foundation noted in a 2015 report. “Both recognize that physical, psychological, social and spiritual issues and concerns, and primary relationships (family and community) impact health and well-being. And both educate, support, and advocate for patients, families and caregivers across all health care settings.”

    A new study by Claire Ankuda and the Robert Graham Center, published in the Annals of Family Medicine, underscores the important role primary care physicians play in caring for people nearing the end of life.


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    The study of 306 hospital regions found that where there was higher primary care physician involvement, Medicare spending per patient was lower for the two years preceding death and that intensive care and hospice use were both less in the last six months.

    It’s well-documented that strong primary care can improve the quality of care and lower healthcare costs. Study after study has shown that states with higher ratios of primary care physicians have lower mortality rates in general, lower rates of neonatal mortality as well as mortality associated with cancer, heart disease and stroke. By controlling these and other chronic conditions, primary care clinicians can improve the health of their patients, keep them out of the hospital and help them live longer.

    That’s why integrating basic palliative care into primary care practice could go a long way toward meeting the needs of people with life-limiting illnesses. For many primary care physicians, the same processes and structures they already use in their practices could facilitate whatever changes might be needed to deliver basic palliative services to their patients.

    In Washington State, the four Seattle-area hospitals associated with the University of Washington Medicine system have taken an innovative approach to palliative care that could also serve as a model for primary care physicians. Through its Primary Palliative Care Clinic, interdisciplinary teams of palliative care professionals—doctors, nurses, social workers, pharmacists and spiritual care providers—work together to develop treatment plans to “prevent and ease suffering” and enhance the quality of life for seriously ill patients “by addressing physical symptoms, emotional, social and spiritual needs, and the practical aspects of daily living.” 

    As specialists in primary (Stream) and palliative care (Nowels), we recognize the need for all healthcare providers to deliver basic palliative care to close the gap between the demand for specialty palliative care and the supply. But it will be impossible to achieve that goal without expanding the capacity of primary care clinicians to provide such care to the growing number of Americans of all ages who need it.


    Glen R. Stream, MD, MBI, is a family physician in La Quinta, California, and president of Family Medicine for America’s Health, which sponsors Health is Primary. David Nowels, MD, MPH, is associate professor of family medicine and director of the Palliative Medicine Fellowship Program at the University of Colorado School of Medicine.

    Glen Stream, MD, FAAFP, MBI
    Dr. Glen Stream, a family physician practicing in La Quinta, California, is past president of the American Academy of Family Physicians. ...


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