Family Practice, Vol 15, 420-425, Copyright © 1998 by World Organization of Family Doctors
G Mitchell
BACKGROUND: With specialist palliative care services becoming widespread,
and the place of the GP in palliative care being examined, audit of patient
care delivered by GPs is required in order to ensure adequate standards of
care. OBJECTIVE: We aimed to evaluate symptomatic care delivered to
palliative care patients by GPs in an Australian community hospice with a
developed quality assurance programme. METHODS: The study was set in a
newly established community-based, GP- run hospice in a provincial city in
Queensland, Australia. A chart audit was carried out of the first 20
patients admitted to a community- based hospice, in order to establish (i)
whether attempts were made by the treating doctor to find the direct cause
of symptoms before initiating management; and (ii) whether management
accorded with developed consensus-based guidelines. RESULTS: Twenty
patients were treated by 14 GPs; 135 new symptoms were identified in the
records of these patients. Of the 125 symptoms for which guidelines could
be identified in the literature, in 87 (70%) an attempt by the treating GP
to find a direct cause could be demonstrated. Of the 114 symptoms with
treatments defined in the guidelines, 107 (90%) treatments conformed to the
guidelines. Constipation, nausea/vomiting, anorexia and back pain were the
conditions for which there were the fewest attempts at establishing a
direct cause before treatment. In most cases these conditions were treated
in accordance with the guidelines. CONCLUSION: Quality assurance mechanisms
present in an in-patient palliative care setting appear to be associated
with high-quality care by GPs.
ORIGINAL CLINICAL RESEARCH
Assessment of GP management of symptoms of dying patients in an Australian community hospice by chart audit
University of Queensland, Centre for General Practice, Medical School, Herston, Australia.
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