[Indicators of structural quality in palliative care for cancer pain patients in Lower-Saxony].
BACKGROUND
Palliative care in Germany fails to reach established standards. To improve this situation the Chamber of Physicians of Lower-Saxony initiated SUPPORT in 1995. Prior to interventions structural quality of care was evaluated, specifically the rate of availability of opioid-prescription-forms and the ability to treat chronic pain (defined as a construct of knowledge, attitudes and skills) were examined.


METHODS
The survey was carried out using a standardized questionnaire mailed to a representative stratified sample of 1200 physicians.


RESULTS
Out of 865 answering physicians (response rate 72.1%) only 36.9% had their own opioid-prescription-forms. Differentiations regarding to specialty, working place (clinic vs. private practice) and treatment of cancer pain patients during the last three months shows a better result for GPs (84.6%), internists (48.6%), gynecologists (51%) and pain specialists (66.7%). Only 33.1% of respondents claimed knowledge of the WHO-3-step-analgesic-ladder. Again the aforementioned differentiations yield somewhat better results for GPs (49.2%), internists (51.5%), gynecologists (34.7%) and pain specialists (55.6%), however only two thirds of these physicians were able to identify the correct number of steps of the WHO-algorithm.


CONCLUSIONS
These results verify an insufficient structural quality in palliative care in Lower-Saxony. In the authors' opinion effective improvements can only be achieved by implementing a parallel strategy:improvement of basic knowledge in pain management with sufficient transfer of this knowledge into practice as well as raising the rate of availability of opioid-prescription-forms,and, on the other hand, establishing local palliative-care-teams with nursing and medical expertise with 24/7 on-demand availability to optimize palliative care.
Ensink
F B M
FB
Arbeitsgruppe SUPPORT der Arztekammer Niedersachsen am Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Georg-August-Universität Göttingen, Germany. fensink@gwdg.de
Bautz
M T
MT
Voss
M C
MC
Görlitz
A
A
Hanekop
G G
GG
D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D005260:Female; D005858:Germany; D006306:Health Surveys; D006801:Humans; D008297:Male; D008511:Medicine; D008875:Middle Aged; D009369:Neoplasms / Q000503:physiopathology*; D010146:Pain / Q000188:drug therapy; D059408:Pain Management; D010166:Palliative Care; D013038:Specialization; D011795:Surveys and Questionnaires
D000700:Analgesics