Abstract
Background: Primary care doctors play an important role in providing palliative care as they are often the first point of contact for most healthcare needs. This study aims to 1) determine the availability and accessibility of palliative care services, in Malaysia, an upper middle income country that has made good progress towards universal health coverage, 2) explore the knowledge, perception, challenges, and opportunities among primary care doctors in providing palliative care services and 3) identify if minimum standards for palliative care service in primary care facilities are achieved.
Methods: A mixed-method study, with a convergent parallel approach was conducted. Access to palliative care was examined by mapping the distance, time taken to travel, and cost to travel to centres offering the services in Malaysia. In-depth interviews were conducted to identify knowledge, perception, challenges, and opportunities among primary care doctors in providing palliative care. Alongside, a survey was conducted to evaluate if minimum standards to deliver palliative care services in primary care facilities in Malaysia are achieved. Here, an audit tool that was adopted from the Indian Minimum National Standards for Palliative Care Tool had been used.
Results: Palliative care was accessible within 4 km in Peninsular Malaysia's highly developed Central Region, whereas patients from the less developed East Coast had to travel about 46 km. Basic palliative care facilities in East Malaysia, which is predominantly rural were 82 km away, and in some cases, when land connectivity was poor, took 2.5 hours to access by boat. The equivalent median travel expenditures in Peninsular Malaysia and East Malaysia were USD2 (RM9) and USD23 (RM114), respectively. The qualitative inquiry suggested that primary care doctors in Malaysia are not adequately empowered to overcome the various challenges and barriers in providing high-quality palliative care to the population although opportunities exist. A total of five themes were identified, namely knowledge and perception, access to palliative care, impact on health workers, patients and caregivers, challenges and barriers, opportunities to improve primary palliative care provision in Malaysia. Lack of skilled healthcare workers, training, policies, a dedicated domiciliary palliative care team at district level and limited access to opioids are among main areas of concern for primary care doctors. The survey meanwhile showed that minimum standards of palliative care services at the primary care level in Malaysia were not universally achieved. Between 57% and 74% of the primary care facilities in Malaysia do not have uninterrupted supply of oral morphine/ step 3 opioids.
Conclusion: There is an urgent need to improve palliative care service delivery in the primary care settings in Malaysia. The palliative care deserts in Malaysia can be overcome by empowering the primary care doctors who are in closer proximity to the public, developing sustainable policies, and establishing a national minimum standard for community palliative care services, to be adopted by all sectors. Restructuring the existing human resource distribution and revising of drug policies are crucial to improve access to community-based palliative care for populations in need.
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@phdthesis{drph-Malar-Velli-2024,
title = {Exploring Facilitators and Barriers Underpinning Palliative Care Development and Access in a Primary Care Setting in Malaysia: A Mixed Method Study},
author = {Malar Velli Segarmurthy},
year = {2024},
date = {2024-04-18},
abstract = {Background: Primary care doctors play an important role in providing palliative care as they are often the first point of contact for most healthcare needs. This study aims to 1) determine the availability and accessibility of palliative care services, in Malaysia, an upper middle income country that has made good progress towards universal health coverage, 2) explore the knowledge, perception, challenges, and opportunities among primary care doctors in providing palliative care services and 3) identify if minimum standards for palliative care service in primary care facilities are achieved.
Methods: A mixed-method study, with a convergent parallel approach was conducted. Access to palliative care was examined by mapping the distance, time taken to travel, and cost to travel to centres offering the services in Malaysia. In-depth interviews were conducted to identify knowledge, perception, challenges, and opportunities among primary care doctors in providing palliative care. Alongside, a survey was conducted to evaluate if minimum standards to deliver palliative care services in primary care facilities in Malaysia are achieved. Here, an audit tool that was adopted from the Indian Minimum National Standards for Palliative Care Tool had been used.
Results: Palliative care was accessible within 4 km in Peninsular Malaysia\'s highly developed Central Region, whereas patients from the less developed East Coast had to travel about 46 km. Basic palliative care facilities in East Malaysia, which is predominantly rural were 82 km away, and in some cases, when land connectivity was poor, took 2.5 hours to access by boat. The equivalent median travel expenditures in Peninsular Malaysia and East Malaysia were USD2 (RM9) and USD23 (RM114), respectively. The qualitative inquiry suggested that primary care doctors in Malaysia are not adequately empowered to overcome the various challenges and barriers in providing high-quality palliative care to the population although opportunities exist. A total of five themes were identified, namely knowledge and perception, access to palliative care, impact on health workers, patients and caregivers, challenges and barriers, opportunities to improve primary palliative care provision in Malaysia. Lack of skilled healthcare workers, training, policies, a dedicated domiciliary palliative care team at district level and limited access to opioids are among main areas of concern for primary care doctors. The survey meanwhile showed that minimum standards of palliative care services at the primary care level in Malaysia were not universally achieved. Between 57% and 74% of the primary care facilities in Malaysia do not have uninterrupted supply of oral morphine/ step 3 opioids.
Conclusion: There is an urgent need to improve palliative care service delivery in the primary care settings in Malaysia. The palliative care deserts in Malaysia can be overcome by empowering the primary care doctors who are in closer proximity to the public, developing sustainable policies, and establishing a national minimum standard for community palliative care services, to be adopted by all sectors. Restructuring the existing human resource distribution and revising of drug policies are crucial to improve access to community-based palliative care for populations in need. },
note = {Doctor of Public Health Thesis},
keywords = {},
pubstate = {published},
tppubtype = {phdthesis}
}
