title: Obstacles to the delivery of primary palliative care as perceived by GPs.
abstract: BACKGROUND
  In order to facilitate GPs in their work and increase the possibilities for patients to remain at home, it is important to identify the obstacles which hinder the delivery of primary palliative care. From previous research we learned about some of the problems experienced by GPs. In this survey we aimed to identify the prevalence of such problems in providing palliative care and its determinants.
  
  
  METHODS
  The prevalence of obstacles and its determinants were identified by a questionnaire to 320 GPs in three regions of the Netherlands. Obstacles were grouped as follows: communication, organisation & co-ordination of care, knowledge & expertise, integrated care, time for relatives. The potential determinants were GP characteristics and expertise development activities.
  
  
  RESULTS
  The response rate was 62.3%. GPs experienced considerable obstacles in all aspects of palliative care. The most prevalent were: problems with bureaucratic procedures (83.9%), the time necessary to arrange home care technology (61.1%) and the difficulties accompanied with the wish or necessity to obtain extra care (56.3%). In general, more years of GP experience and the participation in (multidisciplinary) case discussions were associated with less perceived obstacles.
  
  
  CONCLUSIONS
  Based on the results of our survey policymakers and practitioners can plan and set priorities in handling the obstacles. There is a high necessity of firstly overcoming the barriers within organisation and coordination of care. Furthermore, our study can help in choosing the (additional) expertise needed in the future and in the realisation of the preferred expertise advancement activities.
authors: Centre for Quality of Care Research (114), Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. c.groot@kwazo.umcn.nl
authors: Marieke M
authors: MM
authors: Groot
authors: Myrra J F J
authors: MJ
authors: Vernooij-Dassen
authors: Stans C A
authors: SC
authors: Verhagen
authors: Ben J P
authors: BJ
authors: Crul
authors: Richard P T M
authors: RP
authors: Grol
mesh_terms: D002983:Clinical Competence; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards*; D005194:Family Practice; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009426:Netherlands; D010166:Palliative Care / Q000458:organization & administration / Q000592:standards*; D010348:Patient Care Team; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D011368:Professional-Family Relations; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000458:organization & administration / Q000592:standards*