Primary Palliative Care - Challenges and Resources. The Case of Switzerland

1. Primary Palliative Care - Challenges and Resources. The Case of Switzerland Vanessa Alvarado & Brigitte Liebig University of Applied Sciences Northwestern Switzerland

2. Introduction • Switzerland only recently started to focus on Primary Palliative Care (National Strategy 2013-15) • large differences exist with respect to the legal status and implementation in Swiss cantons • different attitudes towards life preservation, the alleviation of pain and other symptoms across regions • lack of information and knowledge about the conditions of primary palliative care services 2

3. National Research Program 67 “End of Life” (www.nrp.67) • Swiss National Science Foundation • Project : ‘Decision making of General Practitioners in Palliative Care’ • Family doctors play a key role in Primary Palliative Care • Best symptom-management, advanced care planning, the collaboration with families, with ambulant services and medical specialists, pose highest demands on family doctors services and competencies. 3

4. Research questions • Availability of ethic guidelines, recommendations and advance directives for general practice? • Provision of support for family doctors • by specialized care in clinics, nursing homes, hospices? • by ambulatories, of mobile care teams etc.? • Availability of training + further education in palliative care for family doctors? • Financing of medical care services by family doctors? 4

5. Methods • Case Studies in three Swiss cantons, situated in the German, French and Italian speaking part of Switzerland • Expert Questionnaires with public health administrators and palliative care experts on national and cantonal level • Expert Interviews with general practitioners experienced in primary palliative care 5

6. CONDITIONS of PRIMARY PALLIATIVE CAREin SWITZERLAND I 1) Availability of ethic guidelines + ADs • visibility and use of guidelines for family doctors is rather small • FPs are uneasy and unexperienced about using advance directives • but also: generational changes! 2) Support by specialists and ambulant care services • considerable cantonal differences in the provision of specialist palliative care and support by ambulant palliative care services, • as well as between urban and rural areas • lack of collaboration between specialists and general practitioners 6

7. CONDITIONS of Primary Palliative Care in SWITZERLAND II 3) Support of competenciesby education and training • provision of training + further education varies regionally and across cantons • no specific training for family physicians , time constrictions • Some medical societies refuse or are restrictive with credit points for training in PC 4) Financing • poor financial support for palliative care by family doctors : PC activities are represented with a very short time limit • Important PC activities are not financed (e.g. coordination, family support, etc.) • poor financial support for important supply structures for primary palliative care (e.g. the coordination between specialized and primary care, family support, etc.) 7

8. CONCLUSION – STILL A LONG WAY TO GO FOR PRIMARY PALLIATIVE CARE • still not enough visibility of guidelines or ADs in primary palliative care • support structures for primary palliative care vary heavily between cantons, between urban and rural regions • Due to a lack of formal education, primary palliative care is practiced still rather ‘hands on’ • Palliative care provided at home is poorly financed • Small recognition of primary care services in Switzerland 8