Can I Talk to the Doctor? Strategies for Nurse-Led Palliative Programs in Engaging Primary Providers (TH148)

Outcomes 1. Develop strategies to successfully collaborate and communicate with physicians 2. Use telephone and email to successfully to collaborate with physicians Programs that provide palliative care further upstream have proliferated in the last 10-15 years. The palliative care physician shortage is well known, as is the challenge of bringing seriously ill patients into the traditional palliative care clinic setting. As a result, many palliative care programs are administered in the home or telephonically. Nurses are increasingly taking the lead in these programs. Communicating and collaborating with a patient's providers, both primary and specialists, is crucial to providing comprehensive and effective palliative care. This is particularly true with nurse-led programs because prescribing medications for symptoms falls outside their scope of practice. Also, patients’ physicians are often the ones directing the care plans and are therefore trusted and integral players. Engaging these physicians can be challenging for telephonic nurses, and the inability to do so is a barrier to providing cohesive, not siloed care. We will present strategies for physician engagement based on the experiences of an 18-site, PCORI-funded trial of a nurse-led telephonic palliative care program where nurses centralized in New York state provide care to multiple health systems in multiple states; a home-based palliative care program operated within a large health system in 5 states on the West Coast; and a home-based palliative care program operated by a Medicare advantage plan. We will present examples of successful strategies for engaging primary and specialist physicians in different scenarios. Methods of communication have changed in the last 10 years, as have issues of HIPAA privacy compliance, which has offered both opportunities and challenges to communication. There are different challenges when working within a single health system versus multiple health systems as well as community versus academic health systems. Communicating information about advance care planning (ACP) forms versus need for medication prescribing will also be addressed.

成果 1. 制定与医生成功合作和沟通的策略 2. 使用电话和电子邮件与医生成功合作 在过去的10 - 15年中，更早期提供姑息治疗的项目大量增加。姑息治疗医生的短缺是众所周知的，将重症患者引入传统姑息治疗诊所环境所面临的挑战也是如此。因此，许多姑息治疗项目是在患者家中或通过电话实施的。护士在这些项目中日益发挥主导作用。 与患者的初级医疗提供者和专科医生进行沟通和合作，对于提供全面有效的姑息治疗至关重要。对于由护士主导的项目来说尤其如此，因为针对症状开药不在护士的执业范围内。此外，患者的医生往往是指导治疗方案的人，因此是值得信赖且不可或缺的参与者。 对于电话护士来说，与这些医生合作可能具有挑战性，无法做到这一点是提供连贯而非孤立治疗的障碍。我们将根据一项由患者为中心的结果研究所（PCORI）资助的试验经验，介绍与医生合作的策略。该试验涉及一个由护士主导的电话姑息治疗项目，集中在纽约州的护士为多个州的多个医疗系统提供护理；一个在西海岸5个州的大型医疗系统内运营的家庭姑息治疗项目；以及一个由医疗保险优势计划运营的家庭姑息治疗项目。 我们将列举在不同情况下与初级医生和专科医生合作的成功策略示例。在过去10年中，沟通方法发生了变化，《健康保险流通与责任法案》（HIPAA）隐私合规问题也是如此，这既给沟通带来了机遇，也带来了挑战。在单一医疗系统与多个医疗系统内工作，以及在社区医疗系统与学术医疗系统内工作时，都存在不同的挑战。关于预先护理计划（ACP）表格的信息沟通以及开药需求也将得到讨论。