Estimating the Impact of Inpatient Palliative Care Consultations on Health Care Costs in a Low- and Middle-Income Country.

Background: The escalating cost of health care has important implications on national economies and public health. Palliative care (PC) consultations have been shown to reduce health costs while improving the quality of life. Aim: To assess the impact of PC consultations on hospital costs in a low- and middle-income country. Methods: We analyzed billing data of patients who received a PC consultation at our tertiary care hospital over a one-year period. Controls were patients with a serious illness who had at least one admission during the study period. Analysis was conducted for patients discharged alive and those who died during their hospitalization. The primary outcome was cost of hospitalization. Readmission rates, length of stay (LOS), and number of emergency department (ED) visits after discharge were secondary outcomes. Results: Daily hospital costs were 10% lower for patients who received a PC consult (n = 346) compared with controls (n = 698). This difference was more pronounced among patients who died during their hospitalization and when the consult was conducted earlier in the hospital course. LOS (4.92 vs. 4.68, p < 0.0001), readmissions (24.78% vs. 36.41%, p < 0.001), and ED visits after discharge were lower in the PC group compared with the control group (relative risk [RR] = 2.46). Conclusions: We used readily available hospital billing data to demonstrate the cost benefits of inpatient PC consultations. This simple approach can provide powerful data to justify the need for PC services.

Recommendations to Improve Palliative Care Provision for Marginalized Populations: Summary of a Roundtable Discussion.

Palliative care is increasingly recognized as fundamental to health and human dignity. However, a growing body of evidence highlights the variations in access to palliative care based on personal characteristics, belonging to a certain group, and socioeconomic background. Discriminatory attitudes and behaviors and lack of legal reform protecting the rights of marginalized populations are still common, particularly across Lebanon and the Middle East and North Africa region. This article presents a summary of a roundtable discussion organized by the Lebanese Medical Association for Sexual Health in collaboration with the Lebanese Center for Palliative Care-Balsam, focusing on improving palliative care provision for the following populations: prisoners; lesbian, gay, bisexual, and transgender people; refugees; migrant domestic workers; and people with substance use disorder. It also offers recommendations based on the key themes identified from the discussion, in the hope that they will guide the development of guidelines and policy to advance equity in palliative care provision for marginalized populations.

Opioid drugs: what is next for Lebanon?

Opioids remain essential drugs for the treatment of severe cancerous pain. However, many countries have developed new regulations and policies for a better availability and accessibility of these drugs. Lebanon is not too far from these advanced strategies. The Ministry of Health and specifically the Narcotic Department have adjusted regulations related to opioid prescriptions and have registered many new opioid drugs in 2012 for a better pain-free life for our patients. However, there is still a lot to do in this field.

[History of pain: from Greek antiquity to the 21st century]. / Histoire de la douleur: de l'Antiquité grecque au XXIe siècle.

The history of pain is one of the concepts that have divided Cartesian thinkers and mystical philosophers in the Western civilization over centuries. Depending on the historical period, different dogmas and morals intersect, oppose or attempt conciliation. The attitude towards pain evolved with the evolution of mentalities in the broad sense but also by relying on scientific discoveries in the field. Yesterday, pain was accepted or sublimated. Today, taking care of pain is a patient basic right and an obligation for the practitioner.