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Wong BLH, Siepmann I, Rangan A, El-Omrani O, Davis D, Arias-Casais N, Saminarsih DS, Gems D. Involving Young People in Healthy Ageing: A Crucial Facet to Achieving the Decade of Healthy Ageing (2021-2030). Front Public Health 2022; 9:723068. [PMID: 34976908 PMCID: PMC8718601 DOI: 10.3389/fpubh.2021.723068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brian L H Wong
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom.,Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom.,Young Professionals Programme, Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - Ines Siepmann
- Young Professionals Programme, Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium.,Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Apoorva Rangan
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom.,Stanford University School of Medicine, Stanford, CA, United States
| | - Omnia El-Omrani
- Faculty of Medicine, Ain Shams University, Cairo, Egypt.,International Federation of Medical Students' Associations (IFMSA), Copenhagen, Denmark
| | - Daniel Davis
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Natalia Arias-Casais
- Atlantes Global Observatory for Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Diah S Saminarsih
- Office of the Director-General, World Health Organization, Genève, Switzerland
| | - David Gems
- Department of Genetics, Evolution and Environment, Institute of Healthy Ageing, University College London, London, United Kingdom
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Arias-Casais N, Amuthavalli Thiyagarajan J, Rodrigues Perracini M, Park E, Van den Block L, Sumi Y, Sadana R, Banerjee A, Han ZA. What long-term care interventions have been published between 2010 and 2020? Results of a WHO scoping review identifying long-term care interventions for older people around the world. BMJ Open 2022; 12:e054492. [PMID: 35105637 PMCID: PMC8808408 DOI: 10.1136/bmjopen-2021-054492] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/20/2021] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The global population is rapidly ageing. To tackle the increasing prevalence of older adults' chronic conditions, loss of intrinsic capacity and functional ability, long-term care interventions are required. The study aim was to identify long-term care interventions reported in scientific literature from 2010 to 2020 and categorise them in relation to WHO's public health framework of healthy ageing. DESIGN Scoping review conducted on PubMed, CINHAL, Cochrane and Google Advanced targeting studies reporting on long-term care interventions for older and frail adults. An internal validated Excel matrix was used for charting.Setting nursing homes, assisted care homes, long-term care facilities, home, residential houses for the elderly and at the community. INCLUSION CRITERIA Studies published in peer-reviewed journals between 1 January 2010 to 1 February 2020 on implemented interventions with outcome measures provided in the settings mentioned above for subjects older than 60 years old in English, Spanish, German, Portuguese or French. RESULTS 305 studies were included. Fifty clustered interventions were identified and organised into four WHO Healthy Ageing domains and 20 subdomains. All interventions delved from high-income settings; no interventions from low-resource settings were identified. The most frequently reported interventions were multimodal exercise (n=68 reports, person-centred assessment and care plan development (n=22), case management for continuum care (n=16), multicomponent interventions (n=15), psychoeducational interventions for caregivers (n=13) and interventions mitigating cognitive decline (n=13). CONCLUSION The identified interventions are diverse overarching multiple settings and areas seeking to prevent, treat and improve loss of functional ability and intrinsic capacity. Interventions from low-resource settings were not identified.
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Affiliation(s)
- Natalia Arias-Casais
- ATLANTES Global Observatory for Palliative Care, University of Navarra, Pamplona, Spain
| | | | | | - Eunok Park
- College of Nursing, Jeju National University, Jeju, Republic of Korea
| | - Lieve Van den Block
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yuka Sumi
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Ritu Sadana
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Anshu Banerjee
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Zee-A Han
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
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Perracini MR, Arias-Casais N, Thiyagarajan JA, Rapson C, Isaac V, Ullah S, Hyobum J, Sadana R, Han ZA. A Recommended Package of Long-Term Care Services to Promote Healthy Ageing Based on a WHO Global Expert Consensus Study. J Am Med Dir Assoc 2021; 23:297-303.e14. [PMID: 34973958 DOI: 10.1016/j.jamda.2021.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To reach consensus on a minimum list of long-term care (LTC) interventions to be included in a service package delivered through universal health coverage (UHC). DESIGN A multistep expert consensus process. SETTING AND PARTICIPANTS Multinational and multidisciplinary experts in LTC and ageing. METHODS The consensus process was composed of 3 stages: (1) a preconsultation round that built on an initial list of LTC interventions generated by a previous scoping review; (2) 2-round surveys to reach consensus on important, acceptable, and feasible interventions for LTC; (3) a panel meeting to finalize the consensus. RESULTS The preconsultation round generated an initial list of 117 interventions. In round 1, 194 experts were contacted and 92 (47%) completed the survey. In round 2, the same experts contacted for round 1 were invited, and 115 (59%) completed the survey. Of the 115 respondents in round 2, 80 participated in round 1. Experts representing various disciplines (eg, geriatricians, family doctors, nurses, mental health, and rehabilitation professionals) participated in round 2, representing 42 countries. In round 1, 81 interventions achieved the predetermined threshold for importance, and in round 2, 41 interventions achieved the predetermined threshold for acceptability and feasibility. Nine conflicting interventions between rounds 1 and 2 were discussed in the panel meeting. The recommended list composed of 50 interventions were from 6 domains: unpaid and paid carers' support and training, person-centered assessment and care planning, prevention and management of intrinsic capacity decline, optimization of functional ability, interventions needing focused attention, and palliative care. CONCLUSIONS AND IMPLICATIONS An international discussion and consensus process generated a minimum list of LTC interventions to be included in a service package for UHC. This package will enable actions toward a more robust framework for integrated services for older people in need of LTC across the continuum of care.
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Affiliation(s)
- Monica R Perracini
- Ageing and Health Unit, Department of Maternal, Newborn, Child & Adolescent Health and Ageing, WHO, Geneva, Switzerland; Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Natalia Arias-Casais
- Ageing and Health Unit, Department of Maternal, Newborn, Child & Adolescent Health and Ageing, WHO, Geneva, Switzerland; Global Observatory for Palliative Care Institute for Culture and Society University of Navarra, Pamplona, Spain
| | - Jotheeswaran A Thiyagarajan
- Ageing and Health Unit, Department of Maternal, Newborn, Child & Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Colin Rapson
- Ageing and Health Unit, Department of Maternal, Newborn, Child & Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Vivian Isaac
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jang Hyobum
- Ageing and Health Unit, Department of Maternal, Newborn, Child & Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Ritu Sadana
- Ageing and Health Unit, Department of Maternal, Newborn, Child & Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Zee A Han
- Ageing and Health Unit, Department of Maternal, Newborn, Child & Adolescent Health and Ageing, WHO, Geneva, Switzerland.
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Sánchez-Cárdenas MA, Garralda E, Benítez E, Arias-Casais N, van Steijn D, Centeno C. Palliative Care Coverage across European National Health Systems: Proposal of a Synthetic Indicator. Int J Environ Res Public Health 2021; 18:ijerph182010753. [PMID: 34682495 PMCID: PMC8535241 DOI: 10.3390/ijerph182010753] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/08/2021] [Accepted: 10/09/2021] [Indexed: 11/16/2022]
Abstract
Background: The coverage of palliative care (PC) may be understood as a country’s capacity to offer prevention and relief from serious health-related suffering in relation to an existing need. The aim of this study is to estimate European countries´ coverage capacities. Method: Secondary analysis of three indicators, including the number of specialized services (SSPC), integration capacity scores (ICS) and the PC needs. By means of a K-medians clustering supervised algorithm, three coverage profiles were obtained: (1) Advanced: countries with high ICS and SSPC, and low PC needs; (2) Limited: countries with low ICS and SSPC, and low PC needs; and (3) Low: countries with low ICS and SSPC and high PC needs. Results: On average, the ratio of specialized services per population was 0.79 per 100,000 inhabitants, the average ICS was 19.62 and the average number of deceased patients with SHS per 100,000 inhabitants was 5.69. Twenty countries (41%) reached an advanced coverage profile. Nine countries (18%) demonstrated a limited coverage profile; and 20 countries (41%) fell under a low-coverage capacity. Conclusion: The level of palliative care coverage across Europe shows that 59% of European countries have either limited or very low availability of PC resources as regards their palliative care needs.
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Affiliation(s)
- Miguel Antonio Sánchez-Cárdenas
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, 31001 Pamplona, Spain; (E.G.); (N.A.-C.); (D.v.S.); (C.C.)
- IdiSNA—Instituto de Investigacion Sanitaria de Navarra, 31001 Pamplona, Spain
- Correspondence:
| | - Eduardo Garralda
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, 31001 Pamplona, Spain; (E.G.); (N.A.-C.); (D.v.S.); (C.C.)
- IdiSNA—Instituto de Investigacion Sanitaria de Navarra, 31001 Pamplona, Spain
| | - Edgar Benítez
- DATAI, Instituto de Ciencia de los Datos e Inteligencia Artificial, University of Navarra, 31001 Pamplona, Spain;
| | - Natalia Arias-Casais
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, 31001 Pamplona, Spain; (E.G.); (N.A.-C.); (D.v.S.); (C.C.)
- IdiSNA—Instituto de Investigacion Sanitaria de Navarra, 31001 Pamplona, Spain
| | - Danny van Steijn
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, 31001 Pamplona, Spain; (E.G.); (N.A.-C.); (D.v.S.); (C.C.)
- IdiSNA—Instituto de Investigacion Sanitaria de Navarra, 31001 Pamplona, Spain
| | - Carlos Centeno
- ATLANTES Global Palliative Care Observatory, Institute for Culture and Society, University of Navarra, 31001 Pamplona, Spain; (E.G.); (N.A.-C.); (D.v.S.); (C.C.)
- IdiSNA—Instituto de Investigacion Sanitaria de Navarra, 31001 Pamplona, Spain
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Arias-Casais N, Garralda E, Sánchez-Cárdenas MA, Rhee JY, Centeno C. Evaluating the integration of palliative care in national health systems: an indicator rating process with EAPC task force members to measure advanced palliative care development. BMC Palliat Care 2021; 20:36. [PMID: 33627130 PMCID: PMC7905655 DOI: 10.1186/s12904-021-00728-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 02/12/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Palliative care (PC) development cannot only be assessed from a specialized provision perspective. Recently, PC integration into other health systems has been identified as a component of specialized development. Yet, there is a lack of indicators to assess PC integration for pediatrics, long-term care facilities, primary care, volunteering and cardiology. AIM To identify and design indicators capable of exploring national-level integration of PC into the areas mentioned above. METHODS A process composed of a desk literature review, consultation and semi-structured interviews with EAPC task force members and a rating process was performed to create a list of indicators for the assessment of PC integration into pediatrics, long-term care facilities, primary care, cardiology, and volunteering. The new indicators were mapped onto the four domains of the WHO Public Health Strategy. RESULTS The literature review identified experts with whom 11 semi-structured interviews were conducted. A total of 34 new indicators were identified for national-level monitoring of palliative care integration. Ten were for pediatrics, five for primary care, six for long-term care facilities, seven for volunteering, and six for cardiology. All indicators mapped onto the WHO domains of policy and education while only pediatrics had an indicator that mapped onto the domain of services. No indicators mapped onto the domain of use of medicines. CONCLUSION Meaningful contributions are being made in Europe towards the integration of PC into the explored fields. These efforts should be assessed in future regional mapping studies using indicators to deliver a more complete picture of PC development.
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Affiliation(s)
- Natalia Arias-Casais
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, 31080, Pamplona, Spain.
| | - Eduardo Garralda
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, 31080, Pamplona, Spain.,IdiSNA (Institute of Health Research of Navarra), Pamplona, Spain
| | - Miguel Antonio Sánchez-Cárdenas
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, 31080, Pamplona, Spain.,IdiSNA (Institute of Health Research of Navarra), Pamplona, Spain
| | - John Y Rhee
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, 31080, Pamplona, Spain.,Department of Neurology, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carlos Centeno
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, 31080, Pamplona, Spain.,IdiSNA (Institute of Health Research of Navarra), Pamplona, Spain
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Garcia-Quintero X, Parra-Lara LG, Claros-Hulbert A, Cuervo-Suarez MI, Gomez-Garcia W, Desbrandes F, Arias-Casais N. Advancing pediatric palliative care in a low-middle income country: an implementation study, a challenging but not impossible task. BMC Palliat Care 2020; 19:170. [PMID: 33158421 PMCID: PMC7648318 DOI: 10.1186/s12904-020-00674-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/19/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The disparities in access to pediatric palliative care and pain management in Latin America remains an unaddressed global health issue. Efforts to improve the development of Palliative Care (PC) provision have traditionally targeted services for adults, leaving the pediatric population unaddressed. Examples of such services are scarce and should be portrayed in scientific literature to inform decision-makers and service providers on models of care available to tackle the burden of Pediatric Palliative Care (PPC) in Low-and middle-income countries (LMIC). The purpose of this study is to describe the implementation of a pediatric palliative care program, "Taking Care of You" (TCY), in a tertiary care, university hospital in Cali, Colombia. METHODS A program's database was built with children between 0 to 18 years old and their families, from year 2017 to 2019. Descriptive analysis was carried out to evaluate the impact of the program and service delivery. A theory-based method was directed to describe the PPC program, according to the implementation of self-designed taxonomy, mapping theoretical levels and domains. Clinical outcomes in patients were included in the analysis. RESULTS Since 2017 the program has provided PPC services to 1.965 children. Most of them had an oncologic diagnosis and were referred from hospitalization services (53%). The number of ambulatory patients increased by 80% every trimester between 2017 and 2018. A 50% increase was reported in hospitalization, emergency, and intensive care units during the same time period. CONCLUSIONS The program addressed a gap in the provision of PPC to children in Cali. It shows effective strategies used to implement a PPC program and how the referral times, coordination of care, communication with other hospital services were improved while providing compassionate/holistic care to children with life-limiting and threatening diseases and in end-of-life. The implementation of this program has required the onset of specific strategies and arrangements to promote awareness and education proving it a hard task, yet not impossible.
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Affiliation(s)
- Ximena Garcia-Quintero
- Fundación Valle del Lili, Department of Pediatric Palliative Care , Cra 98 # 18 -49, Cali, 760032, Colombia.
| | - Luis Gabriel Parra-Lara
- Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Calle 18 #, 122-135, Cali, Colombia
| | - Angelica Claros-Hulbert
- Fundación Valle del Lili, Department of Pediatric Palliative Care , Cra 98 # 18 -49, Cali, 760032, Colombia
- Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, 760032, Colombia
| | - Maria Isabel Cuervo-Suarez
- Fundación Valle del Lili, Department of Pediatric Palliative Care , Cra 98 # 18 -49, Cali, 760032, Colombia
| | - Wendy Gomez-Garcia
- Dr. Robert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic
| | - Francois Desbrandes
- Pediatric Oncology My Child Matters Program, Pediatric Oncology, Lyon, France
| | - Natalia Arias-Casais
- ATLANTES Global Observatory for Palliative Care, Instituto Cultura y Sociedad (ICS), Universidad de Navarra, Pamplona, Spain
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7
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Arias-Casais N, Garralda E, Pons JJ, Marston J, Chambers L, Downing J, Ling J, Rhee JY, de Lima L, Centeno C. Mapping Pediatric Palliative Care Development in the WHO-European Region: Children Living in Low-to-Middle-Income Countries Are Less Likely to Access It. J Pain Symptom Manage 2020; 60:746-753. [PMID: 32437945 DOI: 10.1016/j.jpainsymman.2020.04.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/18/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
CONTEXT Approximately 170,000 children in need of palliative care die every year in Europe without access to it. This field remains an evolving specialty with unexplored development. OBJECTIVES To conduct the first regional assessment of pediatric palliative care (PPC) development and provision using data from the European Association for Palliative Care atlas of palliative care 2019. METHODS Two surveys were conducted. The first one included a single question regarding PPC service provision and was addressed by European Association for Palliative Care atlas informants. The second one included 10 specific indicators derived from an open-ended interview and rating process; a specific network of informants was enabled and used as respondents. Data were analyzed and presented in the map of the figure. RESULTS Data on PPC service provision were gathered from 51 of 54 (94%) European countries. Additional data were collected in 34 of 54 (62%) countries. A total of 680 PPC services were identified including 133 hospices, 385 home care services, and 162 hospital services. Nineteen countries had specific standards and norms for the provision of PPC. Twenty-two countries had a national association, and 14 countries offered education for either pediatric doctors or nurses. In seven countries, specific neonatal palliative care referral services were identified. CONCLUSION PPC provision is flourishing across the region; however, development is less accentuated in low-to-middle-income countries. Efforts need to be devoted to the conceptualization and definition of the models of care used to respond to the unmet need of PPC in Europe. The question whether specialized services are required or not should be further explored. Strategies to regulate and cover patients in need should be adapted to each national health system.
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Affiliation(s)
- Natalia Arias-Casais
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain.
| | - Eduardo Garralda
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Juan José Pons
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain; Department of History, History of Art and Geography, University of Navarra, Pamplona, Spain
| | - Joan Marston
- Palliative Treatment for Children (PatchSA), Rondebosch, South Africa
| | | | - Julia Downing
- International Children's Palliative Care Network, Bristol, United Kingdom
| | - Julie Ling
- European Association for Palliative Care, Vilvoorde, Belgium
| | - John Y Rhee
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain; Department of Neurology, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard, Boston, Massachusetts, USA
| | - Liliana de Lima
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain; Medical School International Association for Hospice and Palliative Care, Houston, Texas, USA
| | - Carlos Centeno
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain
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Arias-Casais N, López-Fidalgo J, Garralda E, Pons JJ, Rhee JY, Lukas R, de Lima L, Centeno C. Trends analysis of specialized palliative care services in 51 countries of the WHO European region in the last 14 years. Palliat Med 2020; 34:1044-1056. [PMID: 32519584 PMCID: PMC7388149 DOI: 10.1177/0269216320931341] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Service provision is a key domain to assess national-level palliative care development. Three editions of the European Association for Palliative Care (EAPC) Atlas of Palliative Care monitored the changes in service provision across Europe since 2005. AIM To study European trends of specialized service provision at home care teams, hospital support teams, and inpatient palliative care services between 2005 and 2019. DESIGN Secondary analysis was conducted drawing from databases on the number of specialized services in 2005, 2012, and 2019. Ratios of services per 100,000 inhabitants and increase rates on number of services for three periods were calculated. Analysis of variance (ANOVA) analyses were conducted to determine significant changes and chi-square to identify countries accounting for the variance. Income-level and sub-regional ANOVA analysis were undertaken. SETTING 51 countries. RESULTS Forty-two countries (82%) increased the number of specialized services between 2005 and 2019 with changes for home care teams (104% increase-rate), inpatient services (82%), and hospital support teams (48%). High-income countries showed significant increase in all types of services (p < 0.001), while low-to-middle-income countries showed significant increase only for inpatient services. Central-Eastern European countries showed significant improvement in home care teams and inpatient services, while Western countries showed significant improvement in hospital support and home care teams. Home care was the most prominent service in Western Europe. CONCLUSION Specialized service provision increased throughout Europe, yet ratios per 100,000 inhabitants fell below the EAPC recommendations. Western Europe ratios' achieved half of the suggested services, while Central-Eastern countries achieved only a fourth. High-income countries and Western European countries account for the major increase. Central-Eastern Europe and low-to-middle-income countries reported little increase on specialized service provision.
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Affiliation(s)
- Natalia Arias-Casais
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Jesús López-Fidalgo
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain.,Statistical Unit, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Eduardo Garralda
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain.,Healthcare Research Institute of Navarre (IdiSNA), Pamplona, Spain
| | - Juan José Pons
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain.,Department of History, History of Art and Geography, University of Navarra, Pamplona, Spain
| | - John Y Rhee
- Department of Neurology, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Radbruch Lukas
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.,International Association for Hospice & Palliative Care, Houston, TX, USA
| | - Liliana de Lima
- International Association for Hospice & Palliative Care, Houston, TX, USA
| | - Carlos Centeno
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain.,Healthcare Research Institute of Navarre (IdiSNA), Pamplona, Spain
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9
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Arias-Casais N, Centeno C. [The importance of assessing the need for palliative care to avoid unnecessary suffering at life's end]. An Sist Sanit Navar 2020; 43:107-108. [PMID: 31999273 DOI: 10.23938/assn.0755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- N Arias-Casais
- Grupo de Investigación ATLANTES. Instituto Cultura y Sociedad, ICS. Universidad de Navarra..
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10
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Arias-Casais N, Garralda E, López-Fidalgo J, Rhee JY, Pons JJ, de Lima L, Centeno C. Consensus Building on Health Indicators to Assess PC Global Development With an International Group of Experts. J Pain Symptom Manage 2019; 58:445-453.e1. [PMID: 31163260 DOI: 10.1016/j.jpainsymman.2019.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 11/28/2022]
Abstract
CONTEXT International consensus on indicators is necessary to standardize the global assessment of palliative care (PC) development. OBJECTIVES To identify the best indicators to assess current national-level PC development. METHODS Experts in PC development were invited to rate 45 indicators organized by domains of the World Health Organization Public Health Strategy in a two-round RAND/UCLA-modified Delphi process. In the first round, experts rated indicators by relevance, measurability, and feasibility (1-9). Ratings were used to calculate a global score (1-9). Indicators scoring >7 proceeded to the second round for fine-tuning of global scores. Median, confidence interval, Content Validity Index, and Disagreement Index were calculated. Indicators scoring a lower limit 95% confidence interval of ≥7 and a Content Validity Index of ≥0.30 were selected. RESULTS 24 experts representing five continents and several organizations completed the study. 25 indicators showed a high content validity and level of agreement. Policy indicators (n = 8) included the existence of designated staff in the National Ministry of Health and the inclusion of PC services in the basic health package and in the primary care level list of services. Education indicators (n = 4) focused on processes of official specialization for physicians, inclusion of teaching at the undergraduate level, and PC professorship. Use of medicines indicators (n = 4) consisted of opioid consumption, availability, and prescription requirements. Services indicators (n = 6) included number and type of services for adults and children. Additional indicators for professional activity (n = 3) were identified. CONCLUSION The first list including 25 of the best indicators to evaluate PC development at a national level has been identified.
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Affiliation(s)
- Natalia Arias-Casais
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain.
| | - Eduardo Garralda
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain; IdiSNA (Instituto de Investigación Sanitaria de Navarra/Institute of Health Research of Navarra), Pamplona, Spain
| | - Jesús López-Fidalgo
- Universidad de Navarra, ICS, Statistics Unit, Campus universitario, Pamplona, Spain
| | - John Y Rhee
- Department of Medicine, Mount Sinai Hospital, New York, USA
| | - Juan José Pons
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain; Department of History, History of Art and Geography, University of Navarra, Pamplona, Spain
| | - Liliana de Lima
- International Association for Hospice and Palliative Care, Houston, USA
| | - Carlos Centeno
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain; IdiSNA (Instituto de Investigación Sanitaria de Navarra/Institute of Health Research of Navarra), Pamplona, Spain
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Centeno C, Arias-Casais N. Global palliative care: from need to action. Lancet Glob Health 2019; 7:e815-e816. [PMID: 31129121 DOI: 10.1016/s2214-109x(19)30223-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 04/29/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Carlos Centeno
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, Pamplona 31009, Spain.
| | - Natalia Arias-Casais
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Navarra, Pamplona, Spain
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