Evaluación cualitativa del desarrollo del Proyecto Demostrativo OMS de Cuidados Paliativos de Cataluña a los 15 años de su implementación y propuestas de mejora del programa / No disponible

Introducción: la consideración sistemática de elementos cualitativos en la evaluación de programas públicos de cuidados paliativos debe ser igualmente relevante y complementaria de los aspectos cuantitativos habitualmente descritos. Objetivos: describir los resultados del análisis cualitativo del proyecto demostrativo OMS de Cuidados Paliativos de Cataluña a los 15 años, así como las propuestas de mejora. Material y método: el análisis cualitativo se realizó empleando elementos de la metodología EFQM a través de 2 revisiones sistemáticas llevadas acabo por grupos de líderes organizativos y expertos. Se evaluaron 8 dimensiones(Cobertura, Acceso y Equidad, Calidad de servicios, Sistemas y conexión sectorizada, Profesionales, Formación, Investigación, y Financiación). Resultados: los resultados cualitativos muestran como puntos fuertes:la buena cobertura geográfica para los pacientes que sufren cáncer y algo menor para enfermos de otras patologías; la experiencia, diversidad y compromiso de los profesionales; la generación de evidencia científica en temas como efectividad y eficiencia; una percepción de alta satisfacción de enfermos y familias. Las principales áreas de mejora identificadas son: la cobertura para enfermos no oncológicos, la atención continuada, la equidad entre sectores, la variabilidad en la implantación de medidas generales en servicios convencionales, escaso desarrollo de aspectos psicosociales y de políticas de calidad, escasos mecanismos de soporte y reconocimiento profesional y académico y un modelo de financiación y compra poco adaptado a complejidad, entre los principales. Conclusiones: el programa de CP de Cataluña, a los 15 años de su inicio ha demostrado que da respuesta a las necesidades de la población aunque debe ser dinámico e introducir mejoras que se adapten a la realidad cambiante de su entorno y a la madurez de los equipos y profesionales (AU)

Introduction: quality assessment should be considered equally relevant and a complement of the quantitative aspects usually described in the evaluation of public palliative care programmes. Objectives: a) to describe the results of the qualitative evaluation of the WHO Palliative Care Demonstration Programme in Catalonia at 15 years after its implementation; b) to describe quality improvement strategies for public palliative care programmes. Material and method: elements of the EFQM methodology were applied. Palliative care leaders and experts on service organization got together to review and qualitatively assess eight dimensions, including coverage, access and equity, quality of services, links amongst health sectors, professionals, training, research, and funding. Results: the following strengths were identified: good coverage for cancer patients, although less developed for patients affected with other diseases; professional expertise, diverse backgrounds and commitment; the generation of scientific evidence in effectiveness and efficacy; high satisfaction perceived in patients and families. There were several areas for improvement, such as coverage for non-cancer patients; on-call duties; equity amongst health sectors; variability on the implementation of general measures in conventional services; poor development of psychosocial care and quality improvement policies; poor support mechanisms; poor professional and academic recognition, and mechanisms of funding poorly adapted to the complexity of services. Conclusions: the Catalan palliative care programme has demonstrated its capacity to respond well to the needs of the population at 15 years after its implementation. It should, however, be dynamic and able to accept changes in response to the growth and maturity of its professionals (AU)

Predicting place of death of elderly cancer patients followed by a palliative care unit.

To determine the predictors of death outside the palliative care system for elderly cancer patients who were followed by a palliative care unit (PCU), a retrospective review of 199 charts was performed. Comorbidities, current neoplastic disease (location of tumor, months since diagnosis, number of days of PCU follow-up), symptoms, drug use, and social support were recorded. Place of death was not significantly different among sexes. Factors predicting death in the general hospital for men were digestive comorbidities, vomiting, and weakness. For women, disease of the senses was predictive. Although there were no significant differences with respect to place of death between sexes in an older cancer population followed by a PCU, the factors that predicted which patients will die in the hospital for men were generally related to their medical condition, whereas the predictive factors for women were mainly related to functional dependency and social support. Social support had a trend towards predicting the place of death in women.