Dr Paul Gregan Consultant in palliative medicine (half time) General practitioner (half time)

Transcription

1 Dr Paul Gregan Consultant in palliative medicine (half time) General practitioner (half time)

2 THE DOCTOR Tate gallery Luke Fildes 1890 Samuel Luke Fildes 1890 The character and bearing of the doctor throughout the time made a deep impression on my father.

3 Dame Cicely Saunders What matters is not always what you do. what matters is how you do what you do

4 Population pyramid Ireland

5 Republic of Ireland Population rises 4.57m to 6.35m Number of deaths rises 29,000 to 48,000 Old dependency ratio doubles Dependency ratio rises 49% to 75% % >65yo,,,,,,,, % >65yo Invasive cancers (excluding non melanomatous skin cancers) incidence rises 84% for females/107% for males

6 NACPC report 2001 Level 1 palliative care approach practiced by all health care professionals Level 2..general palliative care practiced by those with some additional training/experience in palliative care Level 3 specialist palliative care practiced by those working in services whose core activity is palliative care

7 PLACE OF DEATH & Specialist Palliative Care TOTAL DEATHS In Receipt of SPC Place of Death 27,000 6,188 80% cancer 90% of care in last year of life provided by primary care team 6,750 (25%) 5,400 (20%) 2611 (38%) At home 633 (11%) Community residential facility 645 Nursing Home 12,960 1,288 (10%) Acute Hospital 1,890 1,011 (hospice) Other Primary Palliative Care in Ireland 2011

8 Preferred place of death at hospice referral 81% expressed preference to die at home S.Kelly, 2006

9 Place of care of dying 2014(%) 6 hospital home 26 nursing home/long stay residential hospice

10 %CAUSE OF DEATH-IRELAND circulatory disease CANCER respiratory disease injury /poisoning GIT OTHER 29

11 20 DEATHS IN A GP PRACTICE Murray, Scotland CANCER=5 ORGAN FAILURE=6 DEMENTIA/FRAILTY=7 SUDDEN DEATH=2

12 Figure 1 Different disease trajectories for different illnesses Permission obtained from RAND Corporation Lynn J (2001) Perspectives on care at the close of life. Serving patients who may die soon and their families: The role of hospice and other services. JAMA 285: Booth S et al. (2008) The etiology and management of intractable breathlessness in patients with advanced cancer: a systematic review of pharmacological therapy Nat Clin Pract Oncol 5: doi: /ncponc1034

13 Economics Average length of stay for final admission 22.5 days =22,500euros Average cost per patient for duration of illness of specialist palliative home care service = 686 euro Average total cost per patient dying at home under care of primary care team?? UK an Irish evidence suggests 22-40% of hospital deaths could have been at home

14 Primary care professionals have the potential and ability to provide end of life care for most patients, given adequate training, resources, and, when needed, specialist advice. They share common values with palliative care specialists - holistic, patient centred care, delivered in the context of families and friends S Murray 2004 Professor Scott A Murray St Columba's Hospice Chair of Primary Palliative Care, Primary Palliative Care Research Group

15 National steering committee in primary palliative care 4 year project-hse/icgp/ihf Phase 1 ( )- Identify initiatives that will support the delivery of palliative care by primary care/general practice Phase 2 ( ) develop prioritised initiatives

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17 PRIORITISED RECOMMENDATIONS Develop and implement a palliative care summary for communication with out of hours services Create a system for primary care teams to identify patients with palliative care needs and respond appropriately. Clarify the extent and means of access to 24 hour SPC advice/information. Primary Palliative Care in Ireland 2011

18 Out Of Hours (OOH) electronic Palliative Care Summary to include advanced care plan and DNR status On call SPC advice to OOH Access to medicines OOH Education module for OOH GPs

19 Primary Palliative Care in Ireland 2011

20 Issues- patient Medical cards Access to medication (including out of hours) Priority access to equipment Priority access to nursing care at home Priority access to fair deal beds? Fair deal extension to cover nursing needs at home Access to specialist services including respite care Psychological support Advanced care planning

21 Prioritisation special patient status Medical cards Nursing Nursing home admission Equipment prioritisation Home visits Urgent out-patient visits Disabled parking Other areas

22 Issues -family Psychological support Access to respite Access to nursing support Bereavement support

23 Issues- nursing Access to adequate nursing care packages at home Access to out of hours nursing Access to specialist nursing advice Nursing home palliative care input including advice re ceilings of care and advanced care planning

24 Issues- medical Out of hours provision of palliative care Identification of patients at practice level likely to die in the next year Access to IT support Access to further education Access to specialist advisory service Adequate recompense for care with advanced illness Access to syringe drivers/equipment

25 Gold Standards Framework 2000 GSF Kerry Thomas

26 The 7 c s Communication Co-ordination of care Control of symptoms Continuity of care Continued learning Carer support Care of the dying pathway

27 Gold Standards Framework -Keri Thomas To provide a framework for bettering the care of palliative care patients by the primary care teams- Identifying clearly this group of patients and their carers Assessing their needs Planning their care

28 Hey you Are you interested in getting involved? Are you interested in peer support for your care? Are you interested in research in PPC? Are you interested in helping to advocate for policy in PPC?

29 Join the Irish Association for Palliative Care!!! IAPC special interest group in primary palliative care Inaugural meeting June 25 th 2014

30 Presentation to Joint Oireachtas Committee on Health November 2013 Advocate!

31 Life is mostly froth and bubble, two things stand out like stonekindness in another s trouble, courage in your own.

32 THANK YOU