MMW Fortschritte der Medizin
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The reduction of pain is no longer regarded as the predominant objective of pain therapy. Pain-related impairments in quality of life or daily activities, and anxietyand depression--all of which worsen with progressing pain chronification--increasingly gain importance. Impairments in quality of life in particular often have a greater impact on patients afflicted by pain than by other chronic diseases. ⋯ In addition to a mandatory comprehensive pain diagnostic work-up, pain-related restrictions in daily activities and in quality of life should be documented in primary care facilities and considered in pain management approaches. In a multimodal therapy setting, family practitioners have a key role in thediagnosis of pain and in particularalso in the diagnosis of additional symptoms and impairments accompanying pain.
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On 2009-04-01 the Association of Statutory Health Insurance Physicians Westfalia-Lippe and health insurance organizations made an agreement to implement palliative home care for terminally ill patients. Based on this agreement, family doctors and palliativecardoctorscooperate,supported by coordinators. ⋯ Low-threshold access to palliative care networks(bothfamilydoctorand patientcancontact the palliative care team at any time) improves ambulant palliative care. Non-bureaucratic change from general home palliative care (German abbreviation: AAPV) to specialized home palliative care (SAPV) has proven successful in Westfalia-Lippe. Well-trained and experienced coordinators guarantee multidisciplinary and multiprofessional working of palliative care teams. In order to enhance palliative care in Westfalia-Lippe, data for quality assurance should be defined, periodically collected and evaluated in the future.