Institut Català d’OncologiaICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes

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Palliative Care Services in Settings & demographic scenarios

Xavier Gómez-Batiste MD, PhDDirector, WHO Collaborating Center for Public Health Palliative Care Programs

OSI/WHOCC Workshop 4

Institut Català d’OncologiaICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes

Implementing Palliative Care

Specialist Services

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Specific Resources / settings

Units

Support teams

Outp’s / Day care

Acute Hospitals

Nursing homes

Mid term and long term, RHB, (Sociohealth Centers)

Hospices

Community / home

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Types of services and Levels of complexity

General measures in conventional Services (Hospitals, Primary care, Nursing homes, Emergencies, etc)

Basic suport teams (home, hospitals, comprehensive)

Reference:

complexity+ training+ research

Complete teams Units

Transitional measures: individual Specialist nurses or consultants

Institut Català d’OncologiaICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes

Standards of specific resources

• 1 support team at home / 100.000 h• 80-100 beds / milion habitants (10-20% acute, 40-60% mid term, 20-30% nursing

homes)

• 20-25 full time doctors / milion habitants

• 1 team available in every hospital (units in teaching)

• Models of organisation adapted to demographic scenarios: metropolitans, intermediate, or small sectors < 100.000

• Models in specific resources (cancer institutes, nursing homes, etc)

XGB 2005, WHOCC, 2008

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Implementation strategies of services:

initial phases• To create a nucleus of solid

experiences• Combine different types: home,

hospital, cancer, geriatric,….• Based in feasibility: active leaders,

institutional comittment, …. • Cathalitic measures: support teams,

transitional, …• Define services before starting

implementation

Institut Català d’OncologiaICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes

Models of organisation in

demographic and geographic scenarios

Institut Català d’OncologiaICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes

Sectorized Planning

Needs:Demography

urban, rural, mixed

Resources

Type

cancer, geriatrics, AIDS, other

Complexity

low/high

Mortality / Prevalence

low/high

Specialist Services

+ General

Measures in conventional services

Direct coverage for complex diseases

Good care for non-complex diseases

• Criteria intervention

• Continuing / emergency care

• Coordination

Institut Català d’OncologiaICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes

Demographic and setting scenarios• Demographic• Rural• Urban• Rural-urban• Metropolitan

• Settings• Primary/community care• Nursing homes• Longterm / intermediate• Hospitals: district

general, university• Cancer Institutes

Adapt the organisation to needs and contexts

Institut Català d’OncologiaICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes

Exercise

• Select one setting in your country

• Discuss the models of organization of palliative care services in that setting

Institut Català d’OncologiaICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes

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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

ICO l’HospitaletHospital Duran i ReynalsGran Via de l’Hospitalet, 199-20308908 l’Hospitalet de Llobregat

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