Organisation des soins palliatifs en Belgique - KCE

More documents

Recommendations

Info

6 Palliative Care KCE reports 115 1 INTRODUCTION Palliative care has grown from the desire to improve the quality of life of patients with life-limiting conditions by emphasizing relief from pain and symptoms, by involving their family and friends, and by adopting a holistic, non-curative focus. However, health care systems have limitations to meet adequately the needs of terminal ill patients whilst keeping an optimal balance between costs and quality of care at the end of life 1 . 1.1 BACKGROUND AND AIM OF THE STUDY Belgium also faces a rising prevalence of progressive and chronic illnesses and at some point, those patients will need palliative care, sometimes over a long time period. The paragraph below describes e.g. the report of the Federal Evaluation Cell for Palliative Care that concludes to the diversity of efficacious palliative structures in Belgium with a lack of funding to answer to the rising palliative care demand. Statistics from sickness Funds suggested that palliative advantages at the end of life could be underused by the patients who need them. A patient at home is considered as “palliative” according to his/her life prognosis and this criterion seems often inadequate as he/she lives longer or shorter than expected by his/her physician. A further issue is to know if the care patients receive exactly answers to their palliative needs. Some illustrations are curative treatments that go on for patients with a terminal illness or patients who never get the palliative support that they would need despite of the existing structures. The balance between costs and quality of palliative care also raises questions: the multiple solutions currently on the market imply various investments for the society. Financial considerations might also influence the patient’s and family choice: little information is available on the charges that the patients/family have to pay according to the setting they choose for the palliative care. The aim of this study is to analyse the current situation of palliative care in Belgium and to propose optimal solutions to ensure that palliative patients receive the care most appropriate to their needs. First a systematic literature review analyses the definitions and needs of palliative patients and the palliative care models. An epidemiological study examines the prevalence of palliative patients in different settings and the care that they receive. Finally, the costs of care in the different settings are also examined. Based on these results proposals are made in order to optimize palliative care in Belgium. 1.2 HISTORY AND STRUCTURE OF PALLIATIVE CARE IN BELGIUM The first palliative care service and palliative home care team were created more than 20 years ago. From 1991 onwards the Ministry of Social Affairs financed experiments for palliative care at home, in hospitals and in nursing homes. Palliative networks were created in 1997 (Royal Decree of June 19, 1997) 2 . These networks cover the entire Belgian territory (15 networks in Flanders, 1 bilingual network in Brussels, 8 networks in Wallonia and 1 network in the German-speaking community). The networks develop the following activities: • to heighten public awareness; • to organize palliative care trainings for health caregivers and for volunteer persons; • to coordinate different actions like defining cooperation protocols to guarantee an optimal complementarity between organisations and services; • to give advice and logistic support in order to enhance the efficiency of the actions and the support to patients; • to evaluate the palliative services and to estimate the gap between needs and services.
KCE Reports 115 Palliative Care 7 1.2.1 Support for the palliative patient at home The palliative home care teams were created to support caregivers in the first line of care. The Royal Decree of Oct 13, 1998 3 defined minimal criteria for the agreements between these teams and the ‘Comité van de Verzekering voor Geneeskundige Verzorging’ of the National Institute for Health and Disability Insurance (INAMI– RIZIV) a . In 2008, 28 teams signed such an agreement. As defined in the conventions with INAMI-RIZIV, the palliative home care team has the following missions: • To discuss the problems with the caregivers and to advice them about all aspects of palliative care (e.g. pain and symptom control, psychological and spiritual support); • To inform the patient and his/her family about diagnosis, treatment and prognosis. These two first missions justify that somebody would be on duty for phone calls 24h/24; • To coordinate palliative care by making arrangements with general practitioners, other health care givers and volunteers; • To ensure that the necessary care material is available at the patient’s home; • To provide psychological and spiritual support to the caregivers of the first line of care. In specific situations, only after consultation and with their permission the palliative home care team can perform specific care tasks. Besides the creation of the home care teams, a number of additional measures guarantee a good quality of care for the palliative patient who wishes to die at home. The Royal Decree of December 2, 1999 4 introduced a ‘palliative lump sum’ (“forfait”) for palliative patients staying at home to cover the costs of medicines, aids and medical care materials. This Royal Decree defines the palliative home patient as a person who suffers from one or more irreversible diseases that are evolving unfavourably; his/her physical/psychological situation is seriously and generally deteriorating; therapeutic interventions and revalidation do not longer affect this unfavourable evolution; the prognosis is bad and death is due in short time (life expectancy between 24 hours and 3 months); there are serious physical, psychological, social and spiritual needs that require time-consuming and continuous assistance; if necessary, caregivers with specific competences are called upon and appropriate technical means are used; the patient is staying at home or has the intention to die at home and he/she meets the conditions defined in the form annexed to the Royal Decree. Furthermore, a sum is provided for nursing 5 and the palliative patient at home does not have to pay any personal contribution when treated by nurses, physiotherapists and general practitioners 6-8 . Finally, the creation of palliative day centres aimed to give the family some respite. These centres were first financed as pilot projects by the National Health Insurance Institute (INAMI–RIZIV). In 2006, these pilot projects were transferred to the Communities and integrated in the legislation on geriatric day centres. An evaluation after 3 years functioning should help decision makers to decide about the future of those centres. 1.2.2 Palliative care in hospital Two palliative care structures were set up in the hospitals. First, 379 SP-palliative beds were created, evenly spread over the country. These SP-beds are clustered in Palliative Care Units (PCU) with (minimum) 6 to (maximum) 12 beds. The beds are spread over several hospital units, or united in an independent unit. The number of palliative care units per hospital is restricted to one. Secondly, the palliative function in hospital has been developed for palliative patients not staying in a PCU 2, 9 . This palliative function, obligatory in every hospital, comprises all activities for the treatment, care and support of terminal patients i.e.: a INAMI: Institut National d’Assurance Maladie Invalidité; RIZIV: Rijksinstituut voor ziekte- en invaliditeitsverzekering
Page 1 and 2: Organisation des soins palliatifs e
Page 3 and 4: Organisation des soins palliatifs e
Page 5 and 6: KCE Reports 115B Soins Palliatifs i
Page 7 and 8: KCE Reports 115B Soins Palliatifs i
Page 9 and 10: KCE Reports 115B Soins Palliatifs v
Page 11 and 12: KCE Reports 115B Soins Palliatifs v
Page 13: KCE Reports 115B Soins Palliatifs i
Page 16 and 17: 2 Palliative Care KCE reports 115 5
Page 18 and 19: 4 Palliative Care KCE reports 115 1
Page 22 and 23: 8 Palliative Care KCE reports 115
Page 70 and 71:
56 Palliative Care KCE reports 115
Page 72 and 73:
Page 74 and 75:
Page 76 and 77:
Page 78 and 79:
Page 80 and 81:
Page 82 and 83:
Page 84 and 85:
Page 86 and 87:
Page 88 and 89:
Page 90 and 91:
Page 92 and 93:
Page 94 and 95:
Page 96 and 97:
Page 98 and 99:
Page 100 and 101:
Page 102 and 103:
Page 104 and 105:
Page 106 and 107:
Page 108 and 109:
Page 110 and 111:
Page 112 and 113:
Page 114 and 115:
Page 116 and 117:
Page 118 and 119:
Page 120 and 121:
Page 122 and 123:
Page 124 and 125:
Page 126 and 127:
Page 128 and 129:
Page 130 and 131:
Page 132 and 133:
Page 134 and 135:
Page 136 and 137:
Page 138 and 139:
Page 140 and 141:
Page 142 and 143:
Page 144 and 145:
Page 146 and 147:
Page 148 and 149:
Page 150 and 151:
Page 152 and 153:
Page 154 and 155:
Page 156 and 157:
Page 158 and 159:
Page 160 and 161:
Page 162 and 163:
Page 164 and 165:
Page 166 and 167:
Page 168 and 169:
Page 170 and 171:
Page 172 and 173:
Page 174 and 175:
Page 176 and 177:
Page 178 and 179:
Page 180 and 181:
Page 182 and 183:
Page 184 and 185:
Page 186 and 187:
Page 188 and 189:
Page 190 and 191:
Page 192 and 193:
Page 194 and 195:
Page 196 and 197:
Page 198 and 199:
Page 200 and 201:
Page 202 and 203:
Page 204 and 205:
Page 206 and 207:
Page 208 and 209:
Page 210 and 211:
Page 212 and 213:
Page 214 and 215:
Dépôt légal : D/2009/10.273/41
Page 216 and 217:
35. Etude relative aux coûts poten
Page 218:
108. Le Tiotropium dans le traiteme
show all

Organisation des soins palliatifs en Belgique - KCE

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?