Palliative care in primary care - the challenge for the 21st century

Abstract

The aging of the Portuguese population poses challenges in end-of-life care for primary care and family physicians. The de- velopment of palliative care as an autonomous discipline has led to an understanding that the involvement of primary care and family physicians is essential for the global provision of care. There is evidence that this is an important factor in allowing pa- tients to die at home. This is the preferred place of death for most Europeans, including the Portuguese. Portugal has one of the highest hospital death rates in Europe, possibly reflecting a lack of investment in training primary care physicians for end-of- life care. The creation of the National Plan for Palliative Care, the passage of the Palliative Care Law in Portugal, the creation of the National Network for Continuous Care (in which many family physicians are already taking part), and the provision of in- centives for home visits are examples of recent important measures. However, there are still many barriers to overcome to help family physicians improve the quality of palliative care given by generalists. Areas such as training, the availability of resources, and coordination with specialist palliative care should be targeted for improvement. We are still far from the standards set by other European countries in our ability to offer good end-of-life care to our patients. It is ethically imperative to make pallia- tive care a priority on the General Practice agenda in Portugal.