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Palliative Care Nurses in Primary Care Clinics Reduce Hospital Admissions, Increase Use of Hospice and Home Care for Patients Nearing End of Life


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Palliative Care Fills a Need in Modern Medicine for Holistic Care

By Rick Rader, MD
Director, Morton J. Kent Habilitation Center
Orange Grove Inc.
Former Member, Innovations Exchange Editorial Board


To fully appreciate this innovation, Palliative Care Nurses in Primary Care Clinics Reduce Hospital Admissions, Increase Use of Hospice and Home Care for Patients Nearing End of Life, it’s important to know how palliative care differs from hospice care and what they have in common.

Palliative care means comfort care and makes the hospice philosophy accessible to those with nonterminal conditions. Like hospice care, palliative care is holistic and doesn’t focus on curative care. It includes and goes beyond palliative medicine—which focuses on pain and symptom management—to identify and address social, psychological, and spiritual issues that can impact both an individual’s physical condition and the effectiveness of medical interventions.

With a few exceptions, palliative care isn’t reimbursed by Federal, State, or private health care plans. Nonetheless, more than 1,000 hospitals nationwide now have palliative care programs, resulting in increased patient satisfaction and decreased medical interventions and, thus, lowering costs. Palliative care may be provided at any time during a person’s illness, even from the time of diagnosis. It may be given at the same time as curative treatment.

Hospice care always includes palliative care. However, it is delivered to terminally ill patients who no longer seek treatment to cure them and are expected to live for about 6 months or less. Usually a team of experts, including palliative care doctors, nurses, and social workers, provide this type of care. Chaplains, massage therapists, pharmacists, nutritionists, and others might also be part of the team.

Palliative care can be provided at home, in an assisted living facility, nursing facility, or hospital. Working in partnership with a primary care doctor, the palliative care team provides the following:
  • Expert treatment of pain and other symptoms
  • Close, clear communication
  • Help navigating the health care system
  • Guidance with difficult and complex treatment choices
  • Detailed practical information and assistance
  • Emotional and spiritual support for patients and their families
Primary care physicians are still trying to find the reimbursement code for close, clear communication and spiritual support for patients and their families.

The fact that a discipline like palliative care had to evolve is, in my opinion, a sad, but necessary condemnation of how medicine is practiced today.

The definition of palliative care lies in its allegiance to biopsychosocial care, the same philosophy that formed the foundation of medicine as a profession. However, the “human” in “humanistic medicine” has been short circuited.

If palliative care has served society in one fashion, perhaps it’s as a model for how primary care, psychiatry, pediatrics, urology, nephrology, cardiology, and every other “ology” needs to be rebooted. But, one can't ignore that hospice medicine has been vastly underutilized (by 60 percent)1 for all the wrong reasons.

This suggests that the emergence of palliative care can not solve the complex problem of where medicine has failed. H.L. Mencken observed, “For every complex problem, there is a solution that is simple, neat, and wrong.” Perhaps having palliative care nurses in primary care is the wrong solution.

Reference

1Ogle K, Mavis B, Wyatt GK. Physicians and hospice care: attitudes, knowledge, and referrals. J Palliat Med. 2002 Feb;5(1):85-92. [PubMed]

Disclosure Statement: Dr. Rader has not indicated whether he has financial interests or business/professional affiliations relevant to the work described in this article.

Original publication: December 18, 2008.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: August 13, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: December 21, 2013.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.