Follow-up of patients needing palliative care in general practice

Introduction: Primary healthcare, provided by general practitioners (GPs), is the cornerstone of healthcare reforms in Bulgaria. It is difficult to study palliative care in the primary care setting because of limited numbers of patients and the tendency of severely ill patients not to participate in investigations. The aim of this study was to follow-up consultations in order to gather information about the scope and content of palliative care provided in the general practice setting. Methods: Special observation card was developed, which consisted of questions related to the patient's socio-demographic data, duration of illness, Karnofsky assessment, symptoms and medication, referral process, home visits; and asked for the patient's self-reported assessment of symptoms. The statistical analyses used descriptive statistics, Pearson's chi-square test, and the Kolmogorov-Smirnov test, and correlation analysis. The level of significance was set at P < 0.05. The data were statistically processed with SPSS software (version 17). Results: GPs identified 211 patients and recorded 625 consultations. Functional performance was 50 or less in 45% of patients. Differences in symptom assessments between GPs and patients were found regarding pain, sleep, appetite, and depression. The average number of medications administered per patient was 3.56 +/- 0.06. A considerable proportion of visits ended with referrals. GPs conducted an average of 4.87 +/- 0.84 home visits per patient. Discussion: GPs provide palliative care in the surgery and during home visits, perform a variety of activities. The creation of specialized palliative care services would clarify their role and contribute to improving symptom control and quality of life for patients.