title: GP and nurses' perceptions of how after hours care for people receiving palliative care at home could be improved: a mixed methods study.
abstract: BACKGROUND
  Primary health care providers play a dominant role in the provision of palliative care (PC) in Australia but many gaps in after hours service remain. In some rural areas only 19% of people receiving palliative care achieve their goal of dying at home. This study, which builds on an earlier qualitative phase of the project, investigates the gaps in care from the perspective of general practitioners (GPs) and PC nurses.
  
  
  METHODS
  Questionnaires, developed from the outcomes of the earlier phase, and containing both structured and open ended questions, were distributed through Divisions of General Practice (1 urban, 1 rural, 1 mixed) to GPs (n = 524) and through a special interest group to palliative care nurses (n = 122) in both rural and urban areas.
  
  
  RESULTS
  Questionnaires were returned by 114 GPs (22%) and 52 nurses (43%). The majority of GPs were associated with a practice which provided some after hours services but PC was not a strong focus for most. This was reflected in low levels of PC training, limited awareness of the existence of after hours triage services in their area, and of the availability of Enhanced Primary Care (EPC) Medicare items for care planning for palliative patients. However, more than half of both nurses and GPs were aware of accessible PC resources.Factors such as poor communication and limited availability of after hours services were identified the as most likely to impact negatively on service provision. Strategies considered most likely to improve after hours services were individual patient protocols, palliative care trained respite carers and regular multidisciplinary meetings that included the GP.
  
  
  CONCLUSIONS
  While some of the identified gaps can only be met by long term funding and policy change, educational tools for use in training programs in PC for health professionals, which focus on the utilisation of EPC Medicare items in palliative care planning, the development of advance care plans and good communication between members of multidisciplinary teams, which include the GP, may enhance after hours service provision for patients receiving palliative care at home. The role of locums in after PC is an area for further research.
authors.affiliation: Palliative Care Research Team, School of Nursing and Midwifery, Monash University, Frankston, Victoria 3199, Australia. Heather.Tan@med.monash.edu.au
authors.forename: Heather M
authors.initials: HM
authors.lastname: Tan
authors.forename: Margaret M
authors.initials: MM
authors.lastname: O'Connor
authors.forename: Gail
authors.initials: G
authors.lastname: Miles
authors.forename: Britt
authors.initials: B
authors.lastname: Klein
authors.forename: Peter
authors.initials: P
authors.lastname: Schattner