integrating palliative care in the community

“Integrating palliative care in the community”

Dr Sébastien Moine, France

Marie Lynch, Ireland

EAPC TASKFORCE IN PRIMARY PALLIATIVE CARE

Aim of Todays Session

• Provide European and international context to primary palliative care

• Provide a summary of the content of the EAPC Primary Palliative Care Toolkit

• Explore the barriers and facilitator to enable palliative care in the community

• Present emerging model of practice in France ‘Interprofessional teamwork within Maisons de Sante Pluriprofessionelles in France. An opportunity to develop the palliative approach in primary care?’

• Give direction to primary care practitioners to develop this dimension of work in their own country/practice



Format1. Overview, context introductions, (SM & ML)

2. Learning goals (ALL)

3. Group activity - Raising Awareness (ALL)

4. Short lecture - French SCoP3 project (SM)

5. Group activity – Practice Change (ALL)

6. Short lecture – Tools to support change (ML)

7. Conclusion


Primary Palliative Care

While there is no formal definition of a palliative approach in primary care, the essential idea is that inter professional primary care teams, regardless of the setting of care, should have in place the skills, resources, and processes necessary to recognize, assess, and manage basic palliative care needs in a timely fashion (24 hours a day, 7 days a week) in a community setting (office, home, or long-term care facility).Shadd et al Canadian Family Physician 2013


Cause of Death EU


Disease Trajectories

Death

High

LowMany years

Function

Death

High

LowMonths or years

Function

Organ failure

6

Acute2

Dementia, frailty and decline

7

Death

High

LowWeeks, months, years

Function

5

Cancer

GP has 20 deaths Per list of 2000 patients Per year

Estimate GP Deaths per Disease Grouping Murray et al 2012


Introductions

• Name• Country • Interest in this topic








7. Conclusion


Learning Goals

• Learning goals• Participant profiles• Contact details








7. Conclusion


Group Activity 1 Raising Awareness

• Who are the key actors involved in the care of people approaching the end of their life at your local level?

• What could you do to strengthen access to palliative care given the existing care provision in your area








7. Conclusion

Interprofessional teamwork within Maisons de Santé Pluriprofessionnelles (MSP) in

France. An opportunity to develop the palliative

approach in primary care ?

Dr Sébastien MoineMSP « Les Vignes de l’Abbaye » (Saint Just en Chaussée)

Laboratoire Educations et Pratiques de la Santé, EA 3412, Université Paris 13

EFPC 2015, Amsterdam, Tuesday 1st September

1. Primary care in France

2. Pilot project in Picardy

3. Collaboration between 1ary and 2ary care

4. Research project in primary palliative care

5. Current challenges


Primary health care provision

FragmentedPoorly coordinated

Multi-professionalPopulation approachvs

Methods of payment

Fee for service Fee for service +New forms of remunerationvs

Health paradigm

Prevention(risk factors)

Health promotion(assets)vs

Primary care in France


Multi-professional Primary Health Care Centers:A rising wave?

French observatory of MSP, 2015


Pilot project in Picardy: Multi-professional Primary Health Care Center « The Vines of the Abbey »

7 GPs4 nurses2 physiotherapists1 midwife1 dietetician3 consultants 1 psychotherapist2 EoL care volunteers (at home)


SCoP3 Project

Primary careInterprofessionalCoordinationMDMProactivePlanning


SCoP3 Project


Identification✓


SCoP3 Project


Identification

Multidimensional assessment

✓✓


SCoP3 Project


Identification

Multidimensional assessment

ACP

✓✓?


A geographical, administrative and functional unit: the health territory


A geographical, administrative and functional unit: the health territory

RHA

MPHCMTPCU

MTPCU

N


Partnership agreement between MPHC and PCMT



1/ Identify, Assess, Plan: SCoP3 Project (MPHC VoA)



1/ Identify, Assess, Plan: SCoP3 Project (MPHC VoA)2/ Clinical collaboration; territorial coordination



1/ Identify, Assess, Plan: SCoP3 Project (MPHC VoA)2/ Clinical collaboration; territorial coordination3/ Support to multi-professional primary care (emergency, distressing situations)



1/ Identify, Assess, Plan: SCoP3 Project (MPHC VoA)2/ Clinical collaboration; territorial coordination3/ Support to multi-professional primary care (emergency, distressing situations)4/ Training (medical education and CPD)



1/ Identify, Assess, Plan: SCoP3 Project (MPHC VoA)2/ Clinical collaboration; territorial coordination3/ Support to multi-professional primary care (emergency, distressing situations)4/ Training (medical education and CPD)5/ Advocacy (Early integration, All illnesses, All settings)


SCoP3 research project

Objective: developing and evaluating a complex intervention aiming to promote early identification and a proactive approach of end of life trajectories in MPHCsPopulation: people living with advanced chronic conditions + palliative needs

Methods: Mixed-methods research design- focus groups (GPs, nurses)- interviews (patients, carers)- process evaluation- multicenter cluster RCT

Care setting: Multi-professional primary care (MPHCs)

Expected results: Improving access to specialist palliative care (PCMT, PCU, PCN)


Current challenges

Report by the French Court of Audit (2015) : - Poor access to specialist palliative care- Primary care not sufficiently implied as part of the solution


Current challenges


New law on the Rights of patients at the end of life (2015) : - Focus on continuous deep sedation…- Focus on legally binding advance directives…


Current challenges


New law on the Rights of patients at the end of life (2015) : - Focus on continuous deep sedation…- Focus on legally binding advance directives…! Risk to occult what may

occur 6m, 12m earlier !!!


Current challenges


New law on the Rights of patients at the end of life (2015) : - Focus on continuous deep sedation…- Focus on legally binding advance directives…

Patients involvement in public health policies : - Design- Implementation


Sébastien Moine

[email protected]

@s_moine



Discussion








7. Conclusion


Group Activity 2

• On which components should you focus if you were to support practice change at your level and/or to develop a policy promoting access to palliative care in the community?








7. Conclusion


TOOLKIT for development of palliative care in the community

WWW.EAPCNET.EU

BACKGROUNDA multi-disciplinary EAPC taskforce was established in 2012 to scope the extent of and learn what facilitates and hinders the development of palliative care in the community across Europe.

AIMTo document the barriers and facilitators for palliative care in the community; and to produce a resource toolkit that enthusiasts could use to facilitate the development of palliative care across different countries throughout Europe and possibly worldwide.



Promoting Palliative Care in the Community - Europe

• Context • Status• Research &

Development• Organisational

support


Context

POLICY DRUG EDUCATION IMPLEMENTATION


ContextWHA first ever resolution palliative care: WHA assembly 2014

Palliative care should be integrated in healthcare in all settings

The community setting is particularly singled out

All countries have to report progress by May 2016


ContextWHO Fact SheetPalliative Care July 2015• A sustainable, quality and accessible palliative care

system needs to be integrated into primary health care, community and home-based care, as well as supporting care providers such as family and community volunteers.

• Providing palliative care should be considered an ethical duty for health professionals.

• Specialist palliative care is one component of palliative care service delivery

•Case studies from 20 European countries•List of Barriers and Opportunities•Compilation of report•Scoping of tools and ways patients are identified for palliative approach•vocabulary used and •publication of article

EAPC TASKFORCE Primary Palliative Care activity 2012-2014

Countries with survey completed

Denmark

Albania

Armenia

BelgiumGermany

Ireland

Malta

Netherlands

Portugal

SerbiaCatalonia

Switzerland

UK

Ukraine

Spain

FranceLuxembourg

Norway

Poland

Sweden

http://www.wallpaperss.com/wp-content/wallpaper/Europe-Map-Countries.gif

Questions asked

1.No of specialist palliative care services and beds2.Profile of GP services 3.Arrangement for home visits and OOH advice4.Place of death5.Availability of specialist advice6.National policies/standards/plans7.Service developments 8.Barriers and opportunities9.Supplementary data

Available from WWW.EAPCNET.EU


Examples of EU Implementation frameworks for Primary palliative care

Policy Initiatives Education

initiativesNext stepsPublication

Translated into French and German already

Available from WWW.EAPCNET.EU


Barriers and opportunities

Place of death


Research and Policy – examples in EU

Legal right to palliative care in statute and ‘Charter for the critically ill and the dying’ in 2010 - GermanyNational steering committee in Primary Palliative Care IrelandStrategy for palliative care development adopted in 2009 Serbia National strategy for palliative care with increasing focus on community care – SwitzerlandNational End of Life Care Programme 2008 – EnglandLiving and Dying Well 2008 – ScotlandAction Plan by Ministry of Health – Albania

http://www.wallpaperss.com/wp-content/wallpaper/Europe-Map-Countries.gif


Research and Development

SPICTIdentifying people at risk of deteriorating health and dying

Research and DevelopmentUK


Research and DevelopmentIreland


International Primary Palliative Care Network WWW.IPPCN.ORG

International Primary Palliative Care Network Group

www.ippcn.org


Discussion


CONTACT DETAILS: IPPCN www.ippcn.org : [email protected]

EAPC http://www.eapcnet.eu/Themes/Organisation/Primarycare.aspx

[email protected]@hospicefoundation.ie

http://www.ippcn.org/

mailto:[email protected]

http://www.eapcnet.eu/Themes/Organisation/Primarycare.aspx



integrating palliative care in the community

Healthcare