[Implementing an intermediate level of outpatient palliative care in Germany: Experiences and views of specialised outpatient palliative care teams]

Abstract

Introduction: In the course of the implementation of the German Hospice and Palliative Care Act of 2015, an agreement was reached to establish an intermediate level of outpatient palliative care (BQKPMV) in Germany. By its degree of specialization, this form of care is located between generalist and specialist outpatient palliative care (AAPV/SAPV). It is still unclear which experiences the SAPV teams have gained with the approach of BQKPMV and how it affects their care routines.

Methods: Between May and August 2021, the project team developed and tested a questionnaire for SAPV teams about their experiences with and views on BQKPMV as a care approach at the interface to SAPV. In September 2021, all 58 teams providing SAPV in Lower Saxony were invited to participate. The information provided by the participants was analyzed using descriptive statistics and frequency analyses.

Results: With 52 participants (78% female; mean age of 50 years), a participation rate of 89.7 % was achieved. Twenty-eight participants indicated that they were aware of BQKPMV and its content, and 10 had received a request for cooperation under the BQKPMV program. Fifty percent of these 10 requests (n = 5) led to a cooperation agreement. The following questions were answered only by participants who were familiar with the content of BQKPMV (N = 28). For a majority of 15 participants, the BQKPMV has (rather) no part in day-to-day care in SAPV. From the participants' point of view, BQKPMV largely fails to supplement the existing regulations of SAPV in a meaningful way (n = 14 is not [likely] true), to promote smooth transition between the forms of outpatient palliative care (n = 13 is not [likely] true) and to facilitate communication among the professionals involved (n = 13 is not [likely] true).

Discussion: These results show that the participating SAPV teams know little about BQKPMV and that there has been little cooperation at the interface between SAPV and BQKPMV. In day-to-day care, there is a clear separation between SAPV and BQKPMV provided by general practitioners, which corresponds with the proposition of the legislator by excluding simultaneous provision of both forms of care. The close cooperation between general practitioners and SAPV teams, which is also required under the agreement regarding BQKPMV, leads to challenges in day-to-day care.

Conclusion: It remains unclear whether and to what extent the close cooperation envisaged in the framework of BQKPMV can be put into practice at the interface between general practitioners and SAPV teams in their daily routines. Practical recommendations for advancing BQKPMV are needed, which, for example, address the exclusion of the simultaneous provision of both forms of care. Further developments of BQKPMV should aim at establishing a framework in which the tasks and duties of health care provision are distributed and remunerated in accordance with the competencies and resources of health care providers.

Keywords: Ambulante Versorgung; Health services research; Outpatient care; Palliative care; Palliativversorgung; Versorgungsforschung.