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Table 1 Implementation of PaTz within the context of primary care in the Netherlands

From: PaTz groups for primary palliative care: reinventing cooperation between general practitioners and district nurses in palliative care: an evaluation study combining data from focus groups and a questionnaire

Primary care in the Netherlands In the Netherlands, there are 16.6 million inhabitants. Each year, 77,000 people die of non-acute illnesses and 31% of these die at home [16]. More than half (55%) of Dutch GPs work part time [8]. About half (54%) of GPs work in a group practice, 28% works in a duo practice and 18% of GPs work in a solo practice. GPs see on average three to five palliative care patients a year [15]. Home care is offered by 248 home care organisations and a further 255 care- or nursing homes that also offer home care [17]. There is variation in the services offered by different home care organisations (for instance, some but not all offer domestic help). Experience with and knowledge of palliative care is not readily available in all home care organisations. DNs and home support workers who are confronted with end-of-life care see on average 10 palliative care patients a year [18].
Implementation of PaTz in the Netherlands PaTz started as a pilot in Amsterdam in 2010, after the initiators successfully recruited participants for four PaTz groups within their network. In Amsterdam, the capital of the Netherlands, there are 779 810 inhabitants (in 2011). There are approximately 2306 inhabitants per 1 fte GP availability [19] and over 50 home care organisations [20] in Amsterdam. The first four PaTz groups started with each nine to ten GPs and two to three DNs; a total of 39 GPs from 18 practices (between one and four GPs per practice) and 10 DNs from four different home care organisations. Every two months 60 – 90 minute meetings are held. The meetings are prepared and chaired by one of the participants, mostly a GP, and a palliative care expert is present to provide information on palliative care when needed. During the meetings, patients with palliative care needs are identified and discussed. Also, a topic of interest can be discussed, like a new type of pain medication. During the meetings most of the time is used to discuss the specific needs of patients in palliative care and to organise that care. When needed thematic issues are more in full discussed with the assistance of the present expert. The chairpersons were trained before implementation by the PaTz initiators. The DNs are cleared by their organisations to attend PaTz meetings.