situation thailand patama_29092012
DESCRIPTION
Presentation at the "Building collaborative research platform and professional training workshop for cancer treatment, hospic/palliative care and bioethis in SEA countries" National Taiwan university.TRANSCRIPT
The current situation of pall iative care in Thailand
Patama Gomutbutra MD.Assist Prof. of family medicine
Chiang Mai university [email protected]
Purpose
Process
Performance
WHAT:PERFORMANCE OF PALLIATIVE CARE IN THAILAND
2006
2012
Opioid consumption 3. 96 mg/capita compare with 693 mg/capita of USA
The current situation of palliative care service in Thailand.
THAPS’ survey 2012
Asso.prof. Temsak Phungrassami.Faculty of medicine. University of Songkla.
Rojanasak Thongkhamcharoen .Maesod hospital.
Narumol ArkkakulNational health security office (NHSO)
Health care unit in Thailand
• 1,002 public hospitals 316 registered private hospitals.
• Level of public hospitals - Primary care (community) hospital - Secondary care (general) hospital - Tirtiary care (regional) hospital - University hospital - Specialized center eg. Cancer center
Pri. H Sec.H Tir. H U. H Ca.C Private H.
Percentage of pall iat ive care service in each type of Health care unit
EAPC recommendation: standard and norms for hospice and palliative care 2009 http://www.eapcnet.eu/Themes/Organisation/EAPCStandardsNorms.aspx
Graded system of Palliative care service (European standard)
McCain Chiang Mai Nursing home ( so called hospice)
One GP (my husband)with 7 nurse: 30 beds
Pri. H Sec.H Tir. H U. H Ca.C Private H.
Percentage of Morphine availabil i ty in each type of Health care unit
Pri. H Sec.H Tir. H U. H Private H.Ca.C
Percentage of Physician got PC training in each type of Health care unit
“12” physicians ! have year long
palliative training
year(s)
month (s)
week (s)
day(s)
N/A
Percentage of Nurse got PC training in each type of Health care unit
Pri. H Sec.H Tir. H U. H Ca.C Private H.
year(s)
month (s)
week (s)
day(s)
N/A
Caveat about the results
• Response rate 57% (private hospital 19%)
• Each unit situation may be answered by who not know all information.
Dr. Temsak“ CMU has no pain clinic.
REALLY ! “
Thailand quality of death ???
15
HOW:PROCESS OF PALLIATIVE CARE IN CHIANGMAI UNIVERSITY
Patients contact to local health care unit themselves
Follow up by phone in some case
Training physician
• 4th year MD : Lecture principle• 6th year MD : Practice in
community and sent case report• FM resident
- ward consultation aka.shared care- Home visit (not home hospice
Case report from rural sent via Moodle e-learning
GAP of knowledge & practice
•Practice in community( From med students case reports)
•5% of in CA lung got opioid/BZD for dyspnea
•0% of COPD, CHF
•90% non-hypoxia pt. got home oxygen
Example : Management of advance illness dyspnea
WHY:PURPOSE OF DOING MORE“IMPACT” RESEARCH IN PALLIATIVE CARE
Impact = Support clear massage
• Image triangle “Benefit” “Right” of getting palliative
care
“Indicator” of good death
“Expectation” from optimal treatment
Summary situation of pall iat ive care in Thailand
• Our palliative care is being in the “lag” page
• Initiation/Production is not a big problem
• The problem is Communication/Distribution
Thank you for your attention
• Welcome for.. Question Suggestion
Collaboration
Thank you for
• Prof.Tai-Yuan Chiu and The National Taiwan university• Suandok palliative care team• Dr. Temsak, Dr.Sakol
Dr. Rojjanasak, Dr.Linchong, Dr.Tipaporn