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Objective: To present the process of identification of palliative care patients in a Family Health Strategy´s team in Brazil. Methods: The identification process ocurred 1) using the system of work of a Family Health Strategy Team and the principles of primary care and 2) by applying the SPICT, a tool to help identify patients who might benefit with palliative care. Results: Twenty-three patients were enrolled in the palliative care program at the beginning of the project. By the end of the 12 month period, we had identified 38 patients. Six patients died during the time period. Thus during 2015, 38 people were identified with palliative needs from a total population of 3,000 (1.2% of the practice population). Of these 58% (n=22) were women, 63% (n=24) over 65 years, 74.7% (n=28) reported white ethnicity. The most frequent major diagnoses were cancer (39.5%), psychiatric disease (18.4%), cardiovascular disease (15.8%), frailty (10.5%), dementia (10.5%), and respiratory disease (7.9%). Multimorbity was higher in patients over 65 years (t-test, p=0.009) with a median of four diseases. The most prevalent conditions among those suffering multimorbidity were cardiovascular disease (73.7%), psychiatric disease (65.8%), cancer (50%), frailty (39.5%), diabetes mellitus (31.6%), and respiratory diseases (23.7%). Conclusion: We applied a tool for identifying patients who would benefit from palliative care in primary care in a community of Rio Grande. It was practical and feasible. Its further refinement, implementation and evaluation in Brazil is indicated at community centres of Family Health Strategy, specifically taking account of social and economic factors.
Objetivo: Apresentar o processo de identificação de pacientes de cuidados paliativos em uma equipe de Estratégia de Saúde da Família no Brasil. Métodos: O processo de identificação ocorreu 1) utilizando o sistema de trabalho de uma Equipe de Estratégia de Saúde da Família e os princípios da atenção primária e 2) aplicando o SPICT, uma ferramenta para ajudar a identificar pacientes que poderiam se beneficiar com cuidados paliativos. Resultados: Vinte e três pacientes foram inscritos no programa de cuidados paliativos no início do projeto. Ao final do período de 12 meses, identificamos 38 pacientes. Seis pacientes morreram durante o período. Assim, durante 2015, 38 pessoas foram identificadas com necessidades paliativas de uma população total de 3.000 (1,2% da população de prática). Destes, 58% (n=22) foram mulheres, 63% (n=24) com mais de 65 anos, 74,7% (n=28) relataram etnia branca. Os diagnósticos principais mais frequentes foram câncer (39,5%), doença psiquiátrica (18,4%), doença cardiovascular (15,8%), fraqueza (10,5%), demência (10,5%) e doença respiratória (7,9%). A multimorbidade foi maior em pacientes com mais de 65 anos (t-test, p=0,009) com uma mediana de quatro doenças. As patologias mais prevalentes entre os que sofrem de multimorbilidade foram doença cardiovascular (73,7%), doença psiquiátrica (65,8%), câncer (50%), fragilidade (39,5%), diabetes mellitus (31,6%) e doenças respiratórias (23,7%). Conclusão: Aplicamos uma ferramenta para identificar e gerenciar pacientes que se beneficiariam dos cuidados paliativos na atenção primária em Rio Grande. Sua aplicação é prática e viável. Seu aperfeiçoamento, implementação e avaliação no Brasil é indicado nos centros comunitários de Estratégia de Saúde da Família, levando em conta especificamente fatores sociais e econômicos desse país.
Objetivo: Presentar el proceso de identificación de pacientes de cuidados paliativos en un equipo de Estrategia de Salud de la Familia en Brasil. Métodos: El proceso de identificación se realizó 1) utilizando el sistema de trabajo de un equipo de Estrategia de Salud de la Familia y los principios de atención primaria y 2) aplicando el SPICT, una herramienta para ayudar a identificar los pacientes que podrían beneficiarse con el cuidado pallativo. Resultados: Veinte y trés pacientes fueron inscritos en el programa de cuidados paliativos al inicio del proyecto. Al final del período de 12 meses, habíamos identificado a 38 pacientes. Seis pacientes murieron durante ese período de tiempo. Durante 2015, 38 personas fueron identificadas con necesidades paliativas de una población total de 3.000 (1,2% de la población de la práctica). De estos, 58% (n=22) eran mujeres, 63% (n=24) mayores de 65 años, 74,7% (n=28) reportaron etnia blanca. Los diagnósticos principales más frecuentes fueron cáncer (39,5%), enfermedad psiquiátrica (18,4%), enfermedad cardiovascular (15,8%), Fragilidad (10,5%), demencia (10,5%) y enfermedad respiratoria (7,9%). La multimorbilidad fue mayor en pacientes mayores de 65 años (t-test, p=0,009) con una mediana de cuatro enfermedades. Las enfermedades más prevalentes entre los que padecían múltiples enfermedades fueron enfermedad cardiovascular (73,7%), enfermedad psiquiátrica (65,8%), cáncer (50%), fragilidad (39,5%), diabetes mellitus (31,6%) y enfermedades respiratorias (23,7%). Conclusión: Se aplicó una herramienta para identificar y administrar pacientes que se beneficiarían de los cuidados paliativos en atención primaria en Rio Grande. Fue práctico y factible. Su mayor refinamiento, implementación y evaluación en Brasil está indicado en los centros comunitarios de Estrategia de Salud de la Familia, tomando en cuenta específicamente los factores sociales y económicos de este país.
Asunto(s)
Humanos , Masculino , Femenino , Cuidados Paliativos , Atención Primaria de Salud , Salud PúblicaRESUMEN
BACKGROUND: Despite a National Policy on Pain and Palliative Care (working since 2002) and the Family Health Strategy (primary care), Brazil does not have a strategy to integrate palliative care in primary care. The Atlas of Palliative Care in Latino America (ALCP-2013) did not find any team working with this mode: a primary care teach working. AIM: Propose a model of palliative care in the Public Health Service of Brazil offered through the Primary Care to community. METHOD: The Pilot Project is in the city of Rio Grande, south of Brazil, covering the area 29 with 3000 persons. This area has a team with a family physician, a nurse, a technical nurse and 6 Community Agents of Health (persons of area who work directly with population). The team has 3 aims 1) care: identification of possible patients (using the tracking and opinions of community health workers and the area diagnostics) > evaluation using PIG and SPCIT > care according to needs of these patients 2) awareness and needs assessment of the local/area community with ongoing monthly meetings and community engagement 3) awareness of management institutions in the city. RESULTS: The project started in November of 2014 and the first identification found 51 patients. Evaluation and assessment will begins and this number will be reduced. The first local meeting will happen in January/2015. CONCLUSION: This project seeks to provide a proposal for palliative care offered through primary care in a public health service which does not exist in Brazil.
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BACKGROUND: A multidisciplinary European Association of Palliative Care Taskforce was established to scope the extent of and learn what facilitates and hinders the development of palliative care in the community across Europe. AIM: To document the barriers and facilitators for palliative care in the community and to produce a resource toolkit that palliative care specialists, primary care health professionals or policymakers, service developers, educationalists and national groups more generally could use to facilitate the development of palliative care in their own country. DESIGN: (1) A survey instrument was sent to general practitioners with knowledge of palliative care services in the community in a diverse sample of European countries. We also conducted an international systematic review of tools used to identify people for palliative care in the community. (2) A draft toolkit was then constructed suggesting how individual countries might best address these issues, and an online survey was then set up for general practitioners and specialists to make comments. Iterations of the toolkit were then presented at international palliative care and primary care conferences. RESULTS: Being unable to identify appropriate patients for palliative care in the community was a major barrier internationally. The systematic review identified tools that might be used to help address this. Various facilitators such as national strategies were identified. A primary palliative care toolkit has been produced and refined, together with associated guidance. CONCLUSION: Many barriers and facilitators were identified. The primary palliative care toolkit can help community-based palliative care services to be established nationally.