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Vahos J, Rojas-Cortés R, Daza D, Osorio-Florez LC, Macías Saint-Gerons D, Pastrana T, Muñoz S, Fitzgerald J, Porrás A, Luciani S, Castro JL. Barriers of Access to Opioid Medicines within the Context of Palliative Care in Latin America: The Perception of Health Professionals. J Palliat Med 2023; 26:199-209. [PMID: 36040320 PMCID: PMC9894602 DOI: 10.1089/jpm.2022.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Different sets of barriers have been identified to explain the difficulties in the access and availability of opioid analgesics in palliative care, particularly in low- and middle-income countries, including Latin America. Objective: To validate a structured questionnaire for the access to opioid medicines and to investigate the perception of health professionals regarding access barriers to opioid analgesics in 17 countries of the Latin American Region. Design: Survey to identify the domains and barriers of access to opioid medicines according to health professionals, including physicians, nurses, and pharmacists affiliated to institutions that provide palliative care in Latin America between August 2019 and October 2020. Results: We analyzed responses from 426 health professionals. The median age was 44 years old (ranging from 23 to 73 years) with an average experience in palliative care of 10 years (range: 1-35), 71.8% were women, and 49.8% were affiliated to specialized health care facilities of urban areas (94.6%). The main barriers perceived to be extremely relevant by the respondents were "belief that patients can develop addiction" and "financial limitations of patients" for the patient's domain and the "appropriate education, instruction, and training of professionals" for health professional's domain. Conclusions: It is necessary to develop strategies to strengthen less-developed health systems of the region to review legal frameworks, ensure integrated palliative care systems, and deploy multidisciplinary strategies for sensitizing, training, and raising the awareness of patients, caregivers and, particularly, health professionals regarding appropriate prescription and rational use of opioid analgesics.
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Affiliation(s)
- Juanita Vahos
- Department of Pharmacy, Universidad Nacional de Colombia, Bogotá, Colombia
| | | | - Daniela Daza
- Pharmaceutical Chemist, MSc Epidemiology, Bogota, Colombia
| | | | - Diego Macías Saint-Gerons
- Pan American Health Organization, Washington, DC, USA
- Department of Medicine, University of Valencia, INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain
| | - Tania Pastrana
- Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Sergio Muñoz
- Department of Public Health-CIGES, Faculty of Medicine, Universidad de la Frontera, Temuco, Chile
| | | | - Analía Porrás
- Pan American Health Organization, Washington, DC, USA
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Honinx E, Van den Block L, Piers R, Onwuteaka-Philipsen BD, Payne S, Szczerbińska K, Gambassi G, Kylänen M, Deliens L, Smets T. Large differences in the organization of palliative care in nursing homes in six European countries: findings from the PACE cross-sectional study. BMC Palliat Care 2021; 20:131. [PMID: 34433457 PMCID: PMC8390206 DOI: 10.1186/s12904-021-00827-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 08/11/2021] [Indexed: 11/19/2022] Open
Abstract
Background To be able to provide high-quality palliative care, there need to be a number of organizational structures available in the nursing homes. It is unclear to what extent such structures are actually present in nursing homes in Europe. We aim to examine structural indicators for quality of palliative care in nursing homes in Europe and to evaluate the differences in terms of availability of and access to palliative care, infrastructure for residents and families, multidisciplinary meetings and quality improvement initiatives. Methods A PACE cross-sectional study (2015) of nursing homes in Belgium, England, Finland, Italy, the Netherlands and Poland. Nursing homes (N = 322) were selected in each country via proportional stratified random sampling. Nursing home administrators (N = 305) filled in structured questionnaires on nursing home characteristics. Organization of palliative care was measured using 13 of the previously defined IMPACT structural indicators for quality of palliative care covering four domains: availability of and access to palliative care, infrastructure for residents and families, multidisciplinary meetings and quality improvement initiatives. We calculated structural indicator scores for each country and computed differences in indicator scores between the six countries. Pearson’s Chi-square test was used to compute the p-value of each difference. Results The availability of specialist palliative care teams in nursing homes was limited (6.1–48.7%). In Finland, Poland and Italy, specialist advice was also less often available (35.6–46.9%). Up to 49% of the nursing homes did not provide a dedicated contact person who maintained regular contact with the resident and relatives. The 24/7 availability of opioids for all nursing home residents was low in Poland (37.5%). Conclusions This study found a large heterogeneity between countries in the organization of palliative care in nursing homes, although a common challenge is ensuring sufficient structural access to specialist palliative care services. Policymakers and health and palliative care organizations can use these structural indicators to identify areas for improvement in the organization of palliative care.
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Affiliation(s)
- E Honinx
- End-of-Life Care Research Group, Department of Family Medicine & Chronic Care, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium.
| | - L Van den Block
- End-of-Life Care Research Group, Department of Family Medicine & Chronic Care, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium
| | - R Piers
- Department of Geriatric Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - B D Onwuteaka-Philipsen
- EMGO Institute for Health and Care Research, Department of Public and Occupational Health, Expertise Center for Palliative Care, VU University Medical Center, Van der Boechorstraat 7, 1081 BT, Amsterdam, The Netherlands
| | - S Payne
- Faculty of Health And Medicine, Lancaster University, 46 Bardsea, Bailrigg, Lancaster, LA14YX, UK
| | - K Szczerbińska
- Department of Sociology of Medicine, Chair of Epidemiology and Preventive Medicine, Medical Faculty, Jagiellonian University Medical College, ul. Kopernika 7a, 31-034, Kraków, Poland
| | - G Gambassi
- Department of Internal Medicine, Istituto Di Medicina Interna E Geriatria, Università Cattolica del Sacro Cuore, Largo F. Vito, 1 - 00135, Rome, Italy
| | - M Kylänen
- National Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, 00271, Helsinki, Finland
| | - L Deliens
- End-of-Life Care Research Group, Department of Family Medicine & Chronic Care, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium
| | - T Smets
- End-of-Life Care Research Group, Department of Family Medicine & Chronic Care, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium
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