The Public Health Approach to Palliative Care

Transcription

1 The Public Health Approach to Palliative Care Principles, Models, and International Perspectives A White Paper for The BC Centre for Palliative Care August 2015 Prepared by: Eman Hassan MD. MPH. PhDc QualiHealth Consulting

2 Table of Contents Executive Summary 5 1. Palliative care is an increasingly important public health issue A. Palliative care overview B. Guiding principles to palliative care: C. Why palliative care became an important public health issue? Changes in palliative care practice Growing demand for palliative care Deficiencies in end-of-life care Calls for a New approach to palliative care A. British Columbians call for a holistic value-based approach based on best practices BC Government endorses a needs-based integrating approach to fix gaps in palliative care Palliative care stakeholders in BC affirm the need for a holistic value-based approach B. Worldwide advocacy for a public health approach to quality palliative care A public health approach to palliative care A. What is a public health approach? Definition Principles Operational Levels Ten Essential Strategies/Elements #1: Monitor health status to identify threats to population health #2: Diagnose and investigate health problems in the community #3: Inform, educate, and empower people about health issues #4: Mobilize community partnerships to identify and solve health problems #5: Develop policies and plans that support individual and community health efforts #6: Enforce laws and regulations that protect health and ensure safety #8: Assure a competent health care workforce #9: Evaluate effectiveness, accessibility, and quality of health services #10: Research for new insights and innovative solutions to health problems B. Applying the public health approach to palliative care-impact on care attributes and outcomes38 C. Existing Public Health Palliative Care Models WHO Public Health Palliative Care Model P a g e

3 The Health Promoting Palliative Care Model A public Health approach to palliative care-international Perspectives A. Catalonia World Health Organization Demonstration Project Overview Project Implementation Highlights Project Outcomes Conclusion B. Neighbourhood Network in Palliative Care (NNPC)-Kerala, India NNPC Philosophy NNPC Structure: NNPC Operating Model NNPC Approach NNPC Achievements Conclusion C. Public Health Approach to Palliative Care in the United Kingdom Overview UK National End-of-life Care Strategy UK Providers prioritize public health approaches to death, dying, and loss D. Building Dementia-Friendly Society in Japan Overview Japan s Campaign to Build Compassionate Communities The Campaign s Four Programs Conclusion E. A Public Health Oriented Palliative Care System in Australia Overview Australian National Palliative Care Strategy National Programs Supporting Palliative Care Quality and Outcomes National Programs Promoting Awareness and Understanding of Death and Dying National Programs Supporting Research and Innovation in Palliative Care: Community Engagement and Partnerships in Palliative Care in Australia Conclusion P a g e

4 LIST OF FIGURES FIGURE 1 SPECTRUM OF PALLIATIVE CARE SERVICES FIGURE 2 GUIDING PRINCIPLES TO PALLIATIVE CARE PROGRAMS FIGURE 3 THE BOW TIE MODEL: EARLY INTEGRATION OF PALLIATIVE CARE IN DISEASE MANAGEMENT FIGURE 4 CONCEPTUAL CONGRUENCE BETWEEN THE PUBLIC HEALTH APPROACH AND PALLIATIVE CARE FIGURE 5 THE PUBLIC HEALTH APPROACH OPERATES AT ALL LEVELS FIGURE 6 THE TEN ESSENTIAL STRATEGIES OF THE PUBLIC HEALTH APPROACH FIGURE 7 APPLYING THE PUBLIC HEALTH APPROACH TO PALLIATIVE CARE-IMPACT ON CARE ATTRIBUTES AND OUTCOMES. 38 FIGURE 8 WHO PUBLIC HEALTH PALLIATIVE CARE MODEL- OVERVIEW FIGURE 9 WHO PALLIATIVE CARE MODEL- PROVIDER DISTRIBUTION AT DIFFERENT LEVELS OF CARE FIGURE 10 CATALONIA WHO PUBLIC HEALTH PALLIATIVE CARE PROJECT: RESULTS AT 10, 15, AND 20 YEARS FIGURE 11 KERALA S EXPERIENCE: TYPICAL ACTIVITIES OF NNPC VOLUNTEER GROUPS FIGURE 12 UK DATA SHOWS STEADY INCREASE IN THE PROPORTION OF PEOPLE WHO DIED AT HOME OR IN HOME LIKE SETTINGS FIGURE 13 THE UK GOLD STANDARDS FRAMEWORK- OVERVIEW FIGURE 14 UK DATA: THE GSF HOME CARE PROGRAM REDUCE CRISIS ADMISSIONS AND HOSPITAL DEATHS FIGURE 15 JAPAN: DEMENTIA SUPPORTER CARAVAN MODEL FIGURE 16 JAPAN: OVERVIEW OF THE LONG TERM CARE SYSTEM REFORM FIGURE 17 AUSTRALIA DATA: STEADY IMPROVEMENT IN THE SEVERITY OF PAIN AND OTHER SYMPTOMS IN PATIENTS CARED FOR BY PROVIDERS PARTICIPATING IN THE NATIONAL QUALITY IMPROVEMENT PROGRAM P a g e

5 LIST OF TABLES TABLE 1 THE COMPASSIONATE CITIES CHARTER TABLE 2 DEMOGRAPHIC SCENARIOS AND PROPOSALS OF ORGANIZATION OF SPECIALIST PALLIATIVE CARE SERVICES TABLE 3 CATALONIA WHO PROJECT- PALLIATIVE CARE SERVICES ( ) TABLE 4 CATALONIA WHO PROJECT- ACHIEVED OUTCOMES TABLE 5 UK NATIONAL PALLIATIVE CARE PROGRAMS MAPPED TO THE ESSENTIAL PUBLIC HEALTH APPROACH ELEMENTS TABLE 6 AUSTRALIA S NATIONAL PALLIATIVE CARE STRATEGY TABLE 7 AUSTRALIA S NATIONAL PALLIATIVE CARE PROGRAMS MAPPED TO THE ESSENTIAL PUBLIC HEALTH ELEMENTS P a g e