Essential Medicines List for Palliative Care

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Essential Medicines List for Palliative Care

• Salzburg 2006

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We are here today because....

• We are committed to providing, and encouraging
  others to provide, the highest standards of
  palliative care world-wide.
• We bring to this meeting vast experience in
  palliative care in countries very different from
  each other but all with thousands of people
  needing palliative care.

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We are here because

• There are now gt 8,200 palliative care services
  world-wide
• Increasingly such services are Hospital
  Palliative Care Teams in secondary and tertiary
  referral hospitals
• Palliative care training of doctors and nurses in
  many developing countries is still minimal. They
  are eager to learn.
• All, whether in a developed or a developing
  country, need as much help as we can give them

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We are here because, hopefully, we would all
agree that
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Every person with a life-threatening illness has
the right to receive appropriate palliative care

• Irrespective of their colour, class, creed, or
  financial means

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It is the responsibility of every clinician to
provide appropriate palliative care to those who
need it

• ( Such care might not always be given by a
  primary care doctor but might mean the patient
  being referred to a palliative care service or
  advice sought from one )

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Patients receiving palliative care should be
enabled to receive it in the place of their
choice - home, hospital, hospice, nursing or
care home.

• The options vary from country to country as do
  the chances of patients achieving their wishes

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Many of us know from experience..,,

• That people or groups starting palliative care
  services keep re-inventing the wheel making
  the same mistakes we have all made, trying out
  therapeutic regimens we have already found
  ineffective or too costly.
• Many of our textbooks are too expensive for those
  in developing countries
• These are some of the reasons why the WHO
  Analgesic Ladder was needed and why we are here
  to produce an Essential Medicines List

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Like the WHO ladder the Essential Medicines
List...

• Will not be prescriptive or legally-binding
• Will not suggest therapeutic regimens
• Will not deal with financial costs (though they
  will be well known to most of us)
• Will represent the distillation of our clinical
  experience with 100,000s of patients
• Will, hopefully, be easy to explain,
  substantiate, disseminate and update.

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The Essential Medicines List

• The question of cost and value for money will
  be addressed by those who follow me.
• The question of robust evidence on efficacy of
  medicines in the list will be addressed by others
  who follow me
• Here we address the need for a list and the
  principles associated with its use and
  dissemination world-wide.

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The Essential Medicines List

• Will not contain proprietary preparations
• or deliberately encourage their use
• Will predictably contain some medicines not
  available in countries we represent
• Will be reviewed and updated on a regular basis
• Will carry the authority of the WHO
• Question Are we agreed on that ?

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The Essential Medicines List will be of little
use unless

• Governments legislate for availability and
  accessibility of the listed medicines for
  patients wherever they are being cared for.
• This applies to all on the list and not only
  opioids.
• Question How do we influence governments
• and make this happen ?

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It will be useless unless.

• It is brought to the attention of, and explained
  to, all bodies briefing and trying to influence
  members of parliament and departments of health.
• Such bodies now function in many countries
  explaining palliative care and encouraging
  government support and appropriate legislation
• Question How do we establish such lobbying
  groups and keep them informed ?

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It will be of little use unless..

• It is brought to the attention of all physicians
  and nurses working in generalist and specialist
  palliative care services
• Question How do we achieve this ?
• It is brought to the attention of all doctors and
  nurses providing palliative care, whatever their
  specialty.
• Question How do we achieve this ?

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It will be useless unless ..

• It is brought to the attention of all
  pharmacists, wherever they work
• Question How do we achieve this ?
• It is brought to the attention of all students of
  medicine and nursing, and especially all
  intending to practise palliative care.
• Question How do we achieve this ?

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It will be useless unless.

• It is brought to the attention of all charities
  involved in supporting / funding/ enabling
  Palliative Care worldwide.
• Question How do we achieve this ?
• It is brought to the attention of all national
  and international professional associations /
  societies of those working in palliative care
• Question How do we achieve this ?

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It will be of little use unless.

• It is brought to the attention of editors of
  medical, nursing and pharmaceutical journals and
  given good coverage by them
• (This is particularly important for all
  journals dedicated to palliative medicine and
  palliative care issues)
• Question How do we achieve this ?

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What are your brief comments on..

• The need for a WHO Essential Medicines List
• Lobbying for availability and accessibility
• Making it known to all doctors and nurses
• Making it known to all students and pharmacists
• Making it known to professional associations
• Making it known to editors of professional
  journals
• Making it known to palliative care charities
• Have I missed out anything vitally important
  ?

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A few final thoughts and questions !

• How often should the list be reviewed and updated
  ?
• Should each country adapt the list to take costs
  into account ?
• Are we prepared for the displeasure and
  criticisms of pharmaceutical companies if they
  see the list as threatening sales ?

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Thank You