Do family health clinics provide primary-level palliative care in Ontario and the eastern regions of Quebec?

Objective: To explore the extent to which family health clinics in Ontario and the eastern regions of the province of Quebec provide palliative care.

Design: A cross-sectional survey.

Setting: Ontario and the eastern regions of Quebec.

Participants: The clinic leads of a select group of family health clinics with patient enrolment models in Ontario and the eastern regions of Quebec.

Main Outcome Measures: The types of palliative care services that the clinics provide, as well as the enablers of and barriers to providing palliative care within the 2 provinces.

Results: The overall response rate was 32%. Clinics in both provinces reported providing palliative care to ambulatory patients (83% of Ontario clinics and 74% of Quebec clinics). Only 29 of 102 (28%) Ontario clinics provided on-call services themselves, compared with 31 of 34 (91%) Quebec clinics, with the resulting effect being that more patients were directed to emergency departments in Ontario. Access to palliative care specialist teams for support was higher in Ontario than in Quebec (67% vs 41%, respectively). In Ontario, 56% of practices indicated that they had access to palliative care physicians who could take over the care of their patients with palliative care needs, but a lower number (44%) actually handed over care to these physicians.

Conclusion: A group of clinics are providing full palliative care services to their own patients with palliative care needs, including "on-call" services and home visits, and these serve as role models. In Ontario in particular, substantial gaps still exist with respect to clinics providing their own after-hours coverage and home visits; many rely on other services to provide that care. In Quebec, lack of access to palliative care specialist teams appears to be a key challenge in the areas included in this survey. This survey could help policy makers and funders of health care services ensure that appropriate conditions are put in place for optimal palliative care provision in these clinics, such as coordinating access to on-call coverage and support from palliative care specialist teams, as well as providing education to all physicians and adequate remuneration.