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Palliative Care Service ICO-L’Hospitalet Hospital Duran i Reynals

Palliative Care Service ICO-L’Hospitalet Hospital Duran i Reynals. March 2011. Health network. Home Support Teams ( PADES) District Hospitals Primary Care . Start & Evolution. Programme “Vida als Anys” WHO Demonstration Programme on Palliative Care 1991 – Hospital Support Team (UFISS)

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Palliative Care Service ICO-L’Hospitalet Hospital Duran i Reynals

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  1. Palliative Care Service ICO-L’Hospitalet Hospital Duran i Reynals March 2011

  2. Health network Home Support Teams ( PADES) District Hospitals Primary Care

  3. Start & Evolution Programme “Vida als Anys” WHO Demonstration Programme on Palliative Care 1991 – Hospital Support Team (UFISS) 1995 – PCU + Clinic 1 doctor 3 nurses 1 secretary Model I.C.O. Comprehensive Oncological Care Epidemiology Prevention Research Teaching & Training Medical Oncology Raditherapeutic Oncology Clinical Haematology Palliative Care

  4. 1991 2011 Palliative Care Service Care of Patients & Families Clinical Research QUALY Teaching Dept. WHO collaborating Centre Research on Programmes & Services End of Life Observatory Teaching & Training Evolution & Development

  5. Functional Structure H E A L T H N E T W O R K Research Hospital Support Team Palliative Care Unit Out-patients Clinic

  6. Structure Head of Service Head of Nursing Secretary 3/4 doctor 3/4 nurse Specialties 1 doctor [HUB + Haematology] + 1 doctor [Oncology] 1 nurse 2 doctors 9 nurses + 7 auxiliary nurses 16 beds 2 doctors 1 nurse Pain Clinic Clinical Trials Pain PSO SW Physio Nutr Vol

  7. Activity & outcomes Hospital Support Team (UFISS) • proactive intervention • multidimensional assessment & advise • case management – liaison • 5 level of intervention Consultation from: ICO 67% Oncology 48% Haematology 19% HUB 33% Discharge to: Home 38 % Mortality 30 % Social-Health C. 20 % PCU 10 % Data up-date 12.2010

  8. 24 beds Activity & outcomes Palliative Care Unit • in- patient care based on complexity • comprehensive multidimensional care • Mean Age: 64.6 y. • PPS 40% • PaP-group A+B 84% • ESS II+III 74% • ChT 33% • Cognitive failure (at admission) 31% • CAGE 16% • Psychiatric disorder 28% • Social Worker 44% • Psychologist 32% • Physiotherapy 24% • Nutritionist 7.5% • Pain clinic 11% • Mean Stay: 10.9 days • Mortality 49.3% • Discharge at home 37% • Social-Health C. 14% Data up-date 12.2010

  9. Activity & outcomes Out-patients Clinic • preferential appointment by needs • - multidimensional assessment and care • phone support (clinical nurse) • case management and liaison • available in place: psychologist • social worker • pain specialist • Age: 64 a. • PPS: 70 • ESS II-III: 50% • ChT 40% • Follow-up (median): 110 days • Phone calls (average) 15xd • Social Worker 16% • Psychologist 12.5% • Pain Clinic 17% Porta-Sales et al. JPSM 2005;30:145-53 Data up-date 12.2010

  10. Meyers et al. JPSM 2004 ;28:548-56 Healthcare development Early intervention Greater interface and cooperation with the other oncological services death Anti-tumour treatment Palliative Care Bereavement Support Care Phase I trials www.who.int/cancer/palliative/en/

  11. Partner Acute Hosp community ONC Phase I PAIN PAL HMC RDT hosp USAC hosp ORL SUR RDT MO EMEG HCL PAL Continuous & Shared Care “ping-pong model” “sharing model” Coverage Need & complexity driven Cooperation

  12. Activity & outcomes Research Lines: 1.- Opioids/ Cancer Pain 2.- Digestive symptoms 3.- Uncommon problems 4.- Ethics at the End of Life 5.- Clinical Haematology Shared studies with Qualy [Epi Cancer Pain & HST] 2010 Papers in national journal: 13 Papers in international journals: 6

  13. Activity & outcomes Teaching • Residents • Medical oncology 3-4 per year (2 months) • Haematology 2 per year (1 month) • Anaesthesiology (cancer pain) 4 per year (1/2 month) • Family Medicine 5 per year (1 month) • Pschyconcology 6 per year (2 months) • Nursing students 4 per year (average) • Foreign visitors and stays • Participation in: • Undergraduate and post graduate couses • Masters: ICO- Universitat de Barcelona [Palliative Care] • Universitat Autónoma de Barcelona [Bioethics] • Universidad Rey Juan Carlos ( Madrid) [Bioethics] • Universidad Pontificia Comillas ( Sevilla) [Palliative Care] • Univesidad Autónoma de Madrid [Palliative Care] • Universitat de Vic (Barcelona) [Ageing]

  14. Summary • Service inserted into a Cancer Institute & a Tertiary Teaching Hospital • Care based on complexity- Early Intervention and in diverse fields- Intense clinical activity- Busy teaching- Intense research activity- Reference service in a wide healthcare network • Shared non healthcare activities with other in-house • palliative care resources (i.e. Qualy)

  15. Gran Via, s/n km 2,7 08907 L'Hospitalet - Barcelona Tels. 93 335 70 11 / 90 11 Fax 93 260 77 83 http://www.iconcologia.catsalut.net

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