WHO Public Health approach in the planning and implementation of Palliative care: Experience and evidence from Catalonia Xavier Gomez-Batiste Pal Care , Institut Catala d - PowerPoint PPT Presentation

Loading...

PPT – WHO Public Health approach in the planning and implementation of Palliative care: Experience and evidence from Catalonia Xavier Gomez-Batiste Pal Care , Institut Catala d PowerPoint presentation | free to view - id: 4b8a56-NzE5Y



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

WHO Public Health approach in the planning and implementation of Palliative care: Experience and evidence from Catalonia Xavier Gomez-Batiste Pal Care , Institut Catala d

Description:

WHO Public Health approach in the planning and implementation of Palliative care: Experience and evidence from Catalonia Xavier Gomez-Batiste Pal Care , Institut ... – PowerPoint PPT presentation

Number of Views:167
Avg rating:3.0/5.0
Slides: 35
Provided by: XP499
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: WHO Public Health approach in the planning and implementation of Palliative care: Experience and evidence from Catalonia Xavier Gomez-Batiste Pal Care , Institut Catala d


1
WHO Public Health approach in the planning and
implementation of Palliative care Experience
and evidence from CataloniaXavier
Gomez-BatistePal Care , Institut Catala
dOncologiaSocio-Health, Catalan Department of
HealthSpanish Society for Pall care (SECPAL)
2
CATALONIA
  • 6.7 milion habitants
  • gt 16 gt 65
  • 1 million gt 65 ys
  • 100.000 elderly with pluripathology and
    dependency
  • Dementia 90.000
  • Cancer mortality 13.000
  • Aids 300

3
Catalonia Public Health Care system (universal
coverage, free access)
Hospitals 14.000 beds
Regional Cancer Institute
Sociohealth Centers 5.000
Residential 45.000
Primary care network
4
Background
  • British experience on Hospices model of care and
    internal organisation, but outside the NHS
  • The Public Health approach E. Wilkes (1985)
    Jan Stjernsward (WHO) V Ventafridda

5
PCPC global results 2004
  • Nº total resources 162
  • Interventions/year gt 20.000
  • Coverage cancer 75
  • Cancer vs noncancer 60/40
  • Coverage, geographical 100
  • Total beds 550
  • Beds /milion hab 85
  • Full time doctors 140

6
Units 2001 placement
Hosp Univ 6
Hosp Gen 4
ICO 1
CSS 38
MEP 11
  • Nº total 60
  • Beds 550 (9.5/UCP)
  • Length stay 22.8 days
  • Mortality 69.7
  • Discharges home 23.0

7
Home Care Support Teams
  • Nº total 62
  • Nº new patients/year 250
  • Cancer (46), geriatrics (46), chronic
  • Prevalents 30-40
  • Time intervention 6 weeks
  • Place of death 61 home, 19 CSS, 12 HA
  • Nº total professionals (2003) 318
  • Cost savings of 1.000 euros/patient


8
CP levels of complexity
Complete teams Units
Reference complexity training research
Basic Support Teams
General Measures in Conventional Services
9
Complex metropolitan systems (300-500.000 hab)
levels, coordination
10
ICO Palliative Care Service
  • Unit 16 beds
  • Outpats/DC
  • Support team

CSUB
ICO
PADES UCPSS
11
PCS at ICO basic outputs
  • New patients/year 1.000 (Cancer 100)
  • Median survival 1st visit 3.5 months
  • Mean age 60 years
  • Length of stay (Unit) 9 days
  • Mortality (Unit) 50
  • Cost 30 of Medical Oncology

12
PCS at ICO other aspects
  • Reference for training (Master, Intermediate,
    Basic) more than 5.000 profesionals trained
  • Research CATPAL cooperative group (more than 17
    studies)
  • Quality improvement EFQM model

13
ICO 1998 the ping-pong model
CIR
HMT
ONC
ORL
PAIN
PAL CARE
RDT
URG
Cuidados Paliativos
14
ICO 2005 interphase Oncology-Pal care
UFP
PACMAC
UFM
Palliative Care Service clinic, unit, support
team
Case management Continuing care Emergencies Coordi
nation
UFORL
UFGINE
USAC
From competition to cooperation
15
Death
Diagnosys
Bereavement
Specific Treatment
Suportive care
Palliative care
Terminal care
Complexity vs prognosis
Definitions and trams
16
PVAA 166,8 million 3 of total CHS budget
PCPC 23,7 million 0,43 total CHS budget
17
Legislation and standards
  • Decret Catalunya 1990
  • Recomendaciones de la SECPAL, Ministerio de
    Sanidad (1993)
  • Estàndards de cures pal.liatives, SCS, SCBCP
    (1993)
  • Decreto/orden 1993 (Opioides) Ministerio
  • Plan Nacional de Cuidados Paliativos (2001)
  • Guía de criterios de calidad en cuidados
    paliativos SECPAL, Ministerio Sanidad (2002)
  • Indicadores de calidad en cuidados paliativos
    SECPAL, Ministerio de Sanidad

18
Spain 2002 by Regions
Fuente Directorio SECPAL
19
Spain 1984-2002
Fuente Directorio SECPAL
20
Results on the use and cost of reources
21
COMPARISON 1992-2002 USE/COST OF RESOURCES INGR
malalts / ESTMITJ dies / URGENC malalts
COST euros x 100

(XGB et al, 2002)
22
Hospital Costs 1992 vs 2001(Cost /
process-patient / 6 weeks at 2001 prices)
TESISTAULESTEXTCAPVI1
  • 1992 4.987 euros
  • 2001 1.701 euros
  • Difference 3.286 euros / patient



23
National Policy Elements
  • Evaluation of needs
  • Defined targets, aims and principles
  • Leadership
  • Implementation of specific services
  • General measures in conventional services
  • Opioid availability
  • Education and training
  • Standards, legislation, definition of services
  • Financing model
  • Evaluation
  • Implementation plan with specific budget

24
Principles
  • Measures in all places
  • Sectorized
  • Insertion in preexisting services, including
    sociohealth
  • Gradual implementation
  • Public Planning
  • Public Financement

25
Aims
  • Coverage for all in everywhere
  • Equity and accesibility
  • Quality effectiveness, efficiency, satisfaction
  • Reference WHO

26
Initial key procesess
  • Clear ideas
  • Clear definition of clients and services
  • Leadership
  • Training
  • References/experiences
  • Institutional support

pva20
27
Leadership
  • Joint venture between
  • Ministry of health and financing agency
  • Professionals well trained and highly committed
  • Organisations (Providers) public, profit,
    nonprofit
  • Academic (Universities)

28
General measures
  • Targets Hospitals (oncology, internal medicine,
    geriatrics, emergencies), mid-term and long-term
    resources (nursing homes), primary care teams
  • Training policies, sessions, formal training,
    local references
  • Change of organisation teamwork, presence and
    support of the family
  • Liaison of resources

29
Specific Resources
  • Specific nurses
  • Support teams in hospitals, community, both,
    systems
  • Units type, dimension, placement
  • Nº beds 80-100/milion
  • Placement 10-20 acute, 40-60 sociohealth
    (mid-term), 10-20 residential, 10-20 hospices

30
Types of processes (always combined)
  • Implementation of new specific resources
  • Adaptation of conventional resources (general
    measures)
  • Reallocation of resources (reconversion)
  • Catalythic implementation or investment

31
Palliative care and geriatrics and cancer
  • Links with geriatrics in Sociohealth centers,
    nursing homes, and community
  • Links with cancer in hospitals, cancer centers,
    and the community
  • Both necessary

32
Common Resistances
  • We are already doing so...
  • There is no need of specific services, we will
    do a lot of training....
  • Palliative care services will be seen as places
    to die....
  • This is good for England, USA, or Catalonia, but
    it will not work in our country....

33
Expected results
  • Enormous improvement of the quality of care
  • Effectiveness
  • Efficiency saving more than the structrural cost
  • Satisfaction patients, families, professionals,
    and politicians

34
Palliative Care added values
  • Care and organisation models useful in all the
    system
  • Model of care appliable to other conditions
    earlier
  • Emphasis in quality of life
  • Impact on the global efficiency
  • High patients and families satisfaction
  • Ethical approach
About PowerShow.com