Primary Palliative Care - Challenges and Resources.
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Primary Palliative Care - Challenges and Resources. The Case of Switzerland Vanessa Alvarado & Brigitte Liebig University of Applied Sciences Northwestern Switzerland. Introduction. Switzerland only recently started to focus on Primary Palliative Care (National Strategy 2013-15)

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Primary Palliative Care - Challenges and Resources. The Case of Switzerland

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Primary palliative care challenges and resources the case of switzerland

Primary Palliative Care - Challenges and Resources.

The Case of Switzerland

Vanessa Alvarado & Brigitte Liebig

University of Applied Sciences Northwestern Switzerland


Introduction

Introduction

  • Switzerland only recently started to focus on Primary Palliative Care (National Strategy 2013-15)

  • large differences exist with respect to the legal status and implementation in Swiss cantons

  • different attitudes towards life preservation, the alleviation of pain and other symptoms across regions

  • lack of information and knowledge about the conditions of primary palliative care services

2


Primary palliative care challenges and resources the case of switzerland

  • National Research Program 67 “End of Life” (www.nrp.67)

  • Swiss National Science Foundation

  • Project : ‘Decision making of General Practitioners in Palliative Care’

  • Family doctors play a key role in Primary Palliative Care

  • Best symptom-management, advanced care planning, the collaboration with families, with ambulant services and medical specialists, pose highest demands on family doctors services and competencies.

3


Primary palliative care challenges and resources the case of switzerland

  • Research questions

  • Availability of ethic guidelines, recommendations and advance directives for general practice?

  • Provision of support for family doctors

    • by specialized care in clinics, nursing homes, hospices?

    • by ambulatories, of mobile care teams etc.?

  • Availability of training + further education in palliative care for family doctors?

  • Financing of medical care services by family doctors?

4


Methods

Methods

  • Case Studies in three Swiss cantons, situated in the German, French and Italian speaking part of Switzerland

  • Expert Questionnaires with public health administrators and palliative care experts on national and cantonal level

  • Expert Interviews with general practitioners experienced in primary palliative care

5


Conditions of primary palliative care in switzerland i

CONDITIONS of PRIMARY PALLIATIVE CAREin SWITZERLAND I

1) Availability of ethic guidelines + ADs

  • visibility and use of guidelines for family doctors is rather small

  • FPs are uneasy and unexperienced about using advance directives

  • but also: generational changes!

    2) Support by specialists and ambulant care services

  • considerable cantonal differences in the provision of specialist palliative care and support by ambulant palliative care services,

  • as well as between urban and rural areas

  • lack of collaboration between specialists and general practitioners

6


Primary palliative care challenges and resources the case of switzerland

CONDITIONS of Primary Palliative Care in SWITZERLAND II

3) Support of competenciesby education and training

  • provision of training + further education varies regionally and across cantons

  • no specific training for family physicians , time constrictions

  • Some medical societies refuse or are restrictive with credit points for training in PC

    4) Financing

  • poor financial support for palliative care by family doctors : PC activities are represented with a very short time limit

  • Important PC activities are not financed (e.g. coordination, family support, etc.)

  • poor financial support for important supply structures for primary palliative care (e.g. the coordination between specialized and primary care, family support, etc.)

7


Primary palliative care challenges and resources the case of switzerland

CONCLUSION – STILL A LONG WAY TO GO FOR PRIMARY PALLIATIVE CARE

  • still not enough visibility of guidelines or ADs in primary palliative care

  • support structures for primary palliative care vary heavily between cantons, between urban and rural regions

  • Due to a lack of formal education, primary palliative care is practiced still rather ‘hands on’

  • Palliative care provided at home is poorly financed

  • Small recognition of primary care services in Switzerland

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