Journal of pain and symptom management
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J Pain Symptom Manage · Jul 2009
Developing a template to plan palliative care services: the Welsh experience.
Much specialist palliative care in the U. K. is provided through the voluntary sector, with funding in part from the National Health Service and the remainder from donations. Service development has been ad hoc to date. ⋯ Where there are no beds, hospice-at-home provision provides an alternative model of care, with funding adjusted pro rata. The formula aims to ensure fairness of specialist palliative care provision, available out of hours as well as during the working day, providing patient-focused evidence-based care. This means that the specialist team must meet specialist education standards, act as a resource to generalist teams and use a core clinical data set to allow comparable audits against agreed all-Wales standards.
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A significant proportion of health care resources are consumed at end of life. As a result, decision and policy makers seek cost savings to enhance program planning. Most literature, however, combines the cost of all dying patients and, subsequently, fails to recognize the variation between trajectories of functional decline and utilization of health care services. ⋯ Significant and predictable health care services are required by noncancer patients. Trajectories of costs are significantly different for the four categories of dying Albertans. Trajectories of dying are a useful classification for analyzing health care use and costs.
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J Pain Symptom Manage · Jul 2009
The costs and savings of a regional public palliative care program: the Catalan experience at 18 years.
Conceived as a World Health Organization demonstration project for public health initiatives at the end of life, the palliative care program in Catalonia illustrates the impact that similar initiatives may have in terms of cost savings for a regional health system. In a publicly funded and freely accessible health system, decreasing the number of hospital admissions, shortening the lengths of hospital stay, diminishing the frequency of emergency room consultations, shifting the use of acute hospital beds to palliative care beds for treating advanced disease inpatients, and substantially improving the use of opioids in the community are major determinants of the palliative care program's success. ⋯ In this article, the information gathered over an 18-year trajectory of the program is summarized. Key features of the existing financial models used while developing palliative care in Catalonia are described, and the mechanisms by which palliative care may have contributed to increase savings for the health care system in end-of-life care, from euro3,000,000 in 1995 to euro8,000,000 in 2005, are discussed.
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J Pain Symptom Manage · Jul 2009
Research priorities in health economics and funding for palliative care: views of an international think tank.
At the conclusion of the November 2007 meeting, the assembled international expert group identified the research agenda. The adoption of this agenda would take forward health economic research in palliative care, and generate the necessary data for improved funding decision making, and resource allocation. Recommendations for study included international comparative research into the components of care and settings, evaluative studies, methodologic development and strategies to initiate studies, and make better use of data.
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End-of-life decisions for children can be complicated by disagreements between families and health care teams. These conflicts can lead to moral distress in providers. In addition, difficulties in prognostication aggravate the problem. ⋯ Through a case study of a child with a severe life-limiting syndrome, an analysis of both the ethical and legal implications of parental and team conflict are discussed. An ethics team can help provide guidance for teams and help mediate goals of care discussions with families. Palliative care consultation can also be useful, especially in providing support for both the parent and the child.