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The Catalonia WHO Demonstration Project on Palliative Care implementation: results at 20 years

. The Catalonia WHO Demonstration Project on Palliative Care implementation: results at 20 years. X Gómez-Batiste MD, PhD The ‘Qualy’ End of Life Care Observatory WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia 10 th March 2011.

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The Catalonia WHO Demonstration Project on Palliative Care implementation: results at 20 years

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  1. . The Catalonia WHO Demonstration Project on Palliative Care implementation: results at 20 years X Gómez-Batiste MD, PhD The ‘Qualy’ End of Life Care Observatory WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia 10th March 2011 ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes

  2. Background 80’s Eric Wilkes (Sheffield) Vittorio Ventafridda (Milano) Jan Stjernsward (WHO) Kathy Foley (OSI, NY) Palliative Care as a Public Health topic

  3. Catalonia / Barcelona

  4. Catalonia 2009 7.500.000 inhabitants (4.5 in Metropolitan Barcelona) > 65 years: 17% 60.000 people with dementia 130.000 elderly with pluripatology and dependency Mortality rate: 9 / 1.000 Life expectancy: 79 m / 82 f

  5. Catalonia 2009 Autonomous Government, Parliament, and Regional DoH HCS: Free of charge, universal, accesible Acute beds: 18.000 Socio-Health (geriatric, chronic, dementia, RHB and palliative care): 7.000 beds Nursing homes: 50.000 beds Primary care: Health care centers

  6. Catalonia: Mortality / prevalence Mortality Global : 60.000 Cancer : 16.000 Noncancer chronic: 24.000 Total chronic conditions: 40.000 Prevalence terminal patients: Cancer: 4.000 (mean survl 3 months) Other conditions: 18.000 (mean sl 9 months) Total: 22.000 Estimation based in McNamara, 2006

  7. Quantitative analisys: JPSM, 2007

  8. Care Resources 2009 (Total: 236) HSTs: 49 PCUs: 60 Outps: 50 PADES: 74 Other: 10

  9. Resources CP Cat 2009

  10. Catalonia 2010 Coverage (geographic): 100% Coverage cancer: 73% Coverage non cancer: 40-56% (*) Proportion cancer/noncancer : 50% Nº Dispositives: 236 Beds/milion: 101.6 Full time doctors: 220 (30 / milion) (*) McNamara, 2006

  11. Training 423 health-care professionals (60% doctors and 40% nurses) have been taught PC to Master’s degree level at the University of Barcelona. All nursing schools, 50% of medical and social work schools now include modules of PC. Most family doctors (General Practitioners) have a PC stage of 1 or 2 month’s duration inserted in their specialist training.

  12. Training Primary care Coverage of PC training in primary care professionals: 70.5% Advanced/Master’s degree 3.4% Intermediate 15.2% Basic level 51.9%

  13. Populational impact 1990-2005 - More than 250.000 patients attended - More than 900.000 persons (14% of population) in direct contact with palliative care services

  14. Cost/efficiency

  15. Evaluations of the Catalonia WHO Demonstration Project: Methods - External evaluation of indicators (Suñol et al, 2008) - SWOT nominal group of health-care professionals (Gomez-Batiste et al, 2007) - Focal group of relatives (Brugulat et al, 2008) - Benchmark process (2008) (Gomez-Batiste et al, 2010) - Efficiency (Serra-Prat et al 2002 & Gomez-Batiste et al 2006) - Effectiveness (Gomez-Batiste et al, J Pain Symptom Manage 2010) - Satisfaction of patients and their relatives (Survey CatSalut, 2008)

  16. Effectiveness: Efectpal Efectpal (111 teams): Results Symptoms day 1 day 7 (p < 0.001) R Roca, PhD 2007

  17. Efficiency of PCSs • Multicenter longitudinal study on the use of resources by cancer patients attended by PCSs • Comparison with previous use without PCSs • 171 teams / 395 patients

  18. COMPARISON 1992-2002: USE/COST OF RESOURCES INGR: % malalts / ESTMITJ: dies / URGENC: %malalts COST: euros x 100 (XGB et al, 2006)

  19. Dimensions of PCPHPs Coverage Access / equity / availability / continuity Quality of services Sectorised coordination Opioids Professionals Education and Training Evaluation Research Financing Other…….

  20. Qualitative analisys: results Strong Points Region of 7.3 milion habs High coverage cancer, relative noncancer, and geographical High coverage home care cancer and non cancer Professional’s committment Public Health Planning Insertion in the HCS, diversity, models Effectiveness Efficiency Satisfaction Weak Points Low coverage noncancer, inequity variability, sectors and services (specific and conventional) Difficulties in access and continuing care (weekends) Late intervention Evaluation, emotional support, bereavement, Professionals: low income, support, and academic recognition Financing model and complexity Research and evidence

  21. Proposals

  22. INDICATORS MODEL Indicators per Care line PAL HOSPITAL SUPPORT TEAMS (7) PAL MEDIUM-STAY (6) General Indicators (20) PAL HOME SUPPORT TEAMS (6) LONG-STAY (7) PAL PALLIATIVE (5) DAY CARE (6) OUTPATIENTS (5) Indicators per device PAL PAL Hospitalization Services Day Care & Support Teams

  23. Models in Demographic settings

  24. Organic Law 6/2006 of the 19th July, on the Reform of the Statute of Autonomy of Catalonia ARTICLE 20. THE RIGHT TO UNDERGO THE PROCESS OF DEATH WITH DIGNITY 1. Each individual has the right to receive appropriate treatment of pain and complete palliative attention and to undergo the process of death with dignity. 2. Each individual has the right to express his or her will in advance in order to record instructions regarding any medical treatment or intervention that he or she may undergo. These instructions must be respected especially by medical staff, in accordance with the terms established by the law, if the individualis not able to express his or her wishes personally. The Parliament of Catalonia

  25. . The ‘Qualy’ End of Life Care Observatory WHO Collaborating Centre for Public Health Palliative Care Programmes whocc.info@iconcologia.net +34 93 260 77 36 Institut Català d’Oncologia ICO l’Hospitalet Hospital Duran i Reynals Gran Via de l’Hospitalet, 199-203 08908 l’Hospitalet de Llobregat ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes

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