Improving palliative care provision in primary care: a pre- and post-survey evaluation among PaTz groups.

backgroundIn PaTz (PAlliatieve Thuis Zorg, palliative care at home), modelled after the Gold Standards Framework, GPs and community nurses meet on a regular basis to identify patients with palliative care needs (the PaTz register), and to discuss care for these patients.

aimTo study the effects of the implementation of PaTz, and provide additional analyses on two important elements: the PaTz register and patient discussions. DESIGN AND

settingA pre- and post-evaluation among Dutch GPs (

methodGPs from all 37 PaTz groups filled in questionnaires. Pre- and post-test differences were analysed using multilevel analyses to adjust for PaTz group.

resultsIdentification of patients with palliative care needs was done systematically for more patients after implementation of PaTz compared with before (54.3% versus 17.6%). After implementation, 64.8% of deceased patients had been included on the PaTz register. For these patients, when compared with patients not included on the PaTz register, preferred place of death was more likely to be known (88.1% of patients not on the register and 97.3% of deceased patients included on the register), GPs were more likely to have considered a possible death sooner (>1 month before death: 53.0% and 80.2%), and conversations on life expectancy, physical complaints, existential issues, and possibilities of care occurred more often (60.8% and 81.3%; 68.6% and 86.1%; 22.5% and 34.2%; 60.8% and 84.0%, respectively).

conclusionsImplementation of PaTz improved systematic identification of palliative care patients within the GP practice. Use of the PaTz register has added value.