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To prevent and relieve suffering, and promote quality of life at every stage of life

To prevent and relieve suffering, and promote quality of life at every stage of life. The Jordan Model. Jan Stjernswärd, MD, PhD Svedala, Sweden Frank D. Ferris, MD Center For Palliative Studies San Diego Hospice & Palliative Care. Take Home Message. Universal need Strategy

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To prevent and relieve suffering, and promote quality of life at every stage of life

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  1. To prevent and relieve suffering, and promote quality of life at every stage of life

  2. The Jordan Model Jan Stjernswärd, MD, PhDSvedala, SwedenFrank D. Ferris, MDCenter For Palliative StudiesSan Diego Hospice & Palliative Care

  3. Take Home Message • Universal need • Strategy • Is empowering / changing Jordan in just 18 months

  4. The Need . . .

  5. Jordan • 5.4 million people • 50% < 25 years of age

  6. Jordan • Avg. life expectancy 70.8 yr. ( 2002 ) Each year: • 3 / 1,000 die • 16,000 deaths • 3,300 new cancer patients ( 2000 ) • 70% present stage IV disease

  7. Australia ≈ 60 mg US ≈ 50 mg Global 5.44 mg

  8. Poor availability of morphine Only in IV form (no PO) 2 kg for country / year 16,000 deaths / year = 125 mg / death Only Medical Oncologist can prescribe Only available National Cancer Center Only 3-day supplyat one time Fear of opioid use Physicians Nurses Public No palliative care No home care Jordan in 2001

  9. Opioid Useat San Diego Hospice45% patients with cancer

  10. Projected Opioid NeedJordan, 16,000 deaths / year • All causes, 45% cancer = 68.8 kg / year • All causes, 10% cancer = 15.3 kg / year Not including acute or chronic pain Rx

  11. The Model . . .

  12. WHO Public Health Model Policy DrugAvailability Institutionalization Education

  13. Policy • Relief of pain / palliative care is priority • Funding / service delivery models (Policy makers, regulators) • Drug Availability • Importation quota • Prescribing • Distribution • Dispensing • Administration • Institutionalization • Opinion leaders • Strategic plan • Business plan • Resources • Infrastructure (Pharmacists, drug regulators, law enforcement) (Administrators) • Education • Continuing education courses • Medical, nursing, pharmacy schools • Media (Practicing healthcare providers, trainees, public)

  14. ELNEC Project Jordan Pain Relief and Palliative Care Initiative Ministryof Health

  15. Anonymous Donor His Dream: “Freedom from pain in the Middle East”

  16. Policy . . .

  17. 2001 Met Deputy Minister of Health

  18. 2003 Policy Workshop • 60 policy-makers & clinicians • National Committee on Palliative Care with workgroups on • National policy • Drug availability • Education • 2-day introductory training onPalliative Care

  19. Initiative Leaders • Dr. Jan Stjernswärd • WHO Jordan • Dr. Samir Khleif, King Hussein Cancer Center • Ministryof Health

  20. Ahmad Al KhateibKHCC Dr. Hani BroskWHO Amman

  21. Nation Health Policy 2005 Incorporate palliative care into National Health Act

  22. Drug Availability . . .

  23. 2003 Hikma Jordan • Agreed to manufacture inexpensive 10 mg oral morphine IR tabletsfor Middle East

  24. Opioid Quota 2005 Increased from 2 to 7 kg

  25. Opioid Prescribing 2001 any specially licensed physician can Rx 10 day supply 2005 any physician will be able to Rx 21 day supply

  26. Education . . .

  27. Components of Education • Attitudes • Knowledge • Skills • Behavior Change • Patient / Family Outcomes • Societal Experience Dixon J. Evaluation and the Health Professions, 1978.

  28. March 2004First 3-week Course • 32 participants • 9 physicians • 23 nurses

  29. March 2005Second 3-week Course • 70 participants • 10 hospitals • Teams of physician, nurse & pharmacist • Beginner & advanced courses

  30. Week 1 – Classroom • Beginners – EPEC curriculum • Advanced – case-based and small group discussions Interactive learning

  31. http://www.aacn.nche.edu/elnec

  32. Weeks 2 & 3 - Bedside • 2 clinical sites • Groups of 2 - 3 students • Experiential

  33. King Hussein Cancer Center

  34. King Hussein Cancer Center • 3,000 new patients / year • 140 inpatient beds • Overflowing outpatient clinics • Chemotherapy • Radiation therapy • Surgery

  35. Al Basheer HospitalOncology Clinic • Ministry of Health, Public Hospital • 1,200 new patients / year • 18 inpatient oncology beds • Overflowing outpatient clinics • Chemotherapy • Radiation therapy

  36. Al Basheer Hospital – First dose of oral morphine

  37. KHCC Residents,Attending Staff • Breaking Bad New • When the family says “don’t tell” • Burnout • Dyspnea

  38. Grand RoundsKHCC, Al Basheer • Use of opioids • Bone, neuropathic & abdominal pain • Rx common symptoms • Withholding, withdrawing fluids and nutrition • Presentation skills

  39. Jordan Oncology Society Conference on “Breaking Bad News” > 60 physicians

  40. Jordan Mar 04

  41. Jordan Mar 04

  42. Jordanian Physician 1 “During the first week [in the classroom] I felt that I will not benefit… and it will not do any change in my practice. BUT, after starting practical session a huge and unexpected change happened…I will do every efforts I have to practice this knowledge in my real life.”

  43. 1st Palliative Care Physician

  44. International Fellowship in Palliative Medicine • Over 18 months • 4 – 6 months at San Diego Hospice • 4 months with Faculty in Jordan • Rest of time, supervisedrunning ofservice

  45. Institutionalization . . .

  46. KHCC • Hospice & PalliativeCare Service • 2 physicians • 18+ nurses • 8 bed inpt. unit • Consult service • Outpt. clinic • Homecare

  47. KHCC Palliative Care

  48. KHCC Palliative Homecare

  49. KHCC, New Patients 2005

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