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Transforming health care globally… through palliative care. www.PalliativeMed.org www.IPCRC.net. Public Health Perspective on Palliative Care: Transforming Healthcare in Sweden. Frank D. Ferris, MD, FAAHPM, FAACE Institute for Palliative Medicine at San Diego Hospice

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Transforming health care globally… through palliative care


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    1. Transforming health care globally… through palliative care www.PalliativeMed.org www.IPCRC.net

    2. Public Health Perspective on Palliative Care: Transforming Healthcare in Sweden Frank D. Ferris, MD, FAAHPM, FAACE Institute for Palliative Medicineat San Diego Hospice University of California San Diego University of Toronto

    3. Imagine . . .

    4. What do YouWant Your Illness Experience to be ?

    5. 1 2 4 3

    6. Where would you like to receive your care? Acute care Long-term care Home

    7. Swedish Life Expectancy Age 0 2009 = 81.4 World Bank Data

    8. How many are 50 - 60 ? Likely to die 2030s – 2040s…

    9. How will you achieve your goals ? Who will provide your care ?

    10. Transforming health care… through palliative care www.PalliativeMed.org www.IPCRC.net

    11. Objective…A Road Map to Build Palliative Care ( PC )Capacity in Sweden…

    12. Success & Challenges…

    13. Mortality as an Indicator of Need( 2008 est., x 1,000 ) All Causes Cancer AIDS • World 55.678 7.56 2.845 • Late Presentation • Low Resources • Limited or No Treatment

    14. Palliative Care Service Development Globally (from the International Observatory on End-of-Life Care of Lancaster, UK) No activity yet identified Capacity building activity Localized provision Approaching integration 1 2 3 99 / 144 LMICs have no services 4 # Countries Source of Map: Wright et al., J. Pain Sym. Manag. 35:469 (2008) Bar graph created from data in this publication.

    15. Mortality as an Indicator of Need( 2008 est., x 1,000 ) All Causes Cancer AIDS • Sweden 91,5 22,1 -- 8 % of all dying, 30% dying of cancer receive PC • USA2.540 586 14 42 % receive hospice care ( 2010 ) Many more receive non-hospice palliative care

    16. Sweden Vital Statistics… 2012 2040 Population 9,3 M 10,6 M % 65+ 18,3 % 25,8 % % 80+ 5,5 % 9,4 % Dependency ratio 28,1 44,6 Crude death rate 10 12 per 100 K Deaths 93 K 127 K Due to cancer 25 K > 32 K

    17. Sweden Vital Statistics

    18. Palliative Care in Sweden 2012 In 2012 • 93 K deaths all causes • > 60 % benefit from PC ≈ 55.800 • > 22.000 K deaths from cancer • > 80 % benefit from PC > 18.000

    19. Causes of Death • Cardiovascular 39,4 % • Cancer 26,5 % • Neurological 3,4 % • Injuries 3,7 % • Respiratory 5,8 % 90 % of patients receiving PC have cancer !

    20. Setting of Death North America • 23 % own home • 77 % die in institutions( Teno et al, 1997 ) • 2 / 3 in hospitals • 1 / 3 in nursinghomes Sweden • 5 – 10 % own home • 40 – 50 % nursing homes

    21. 1993  2002 ‘ One Voice ’

    22. 2002 National Model Canadian Hospice Palliative CareAssociation • Consensus • Common language • Norms of practice • English et Français

    23. Palliative Care…•Prevents & relieves suffering• Improves quality of living and dying• Any diagnosis From: Ferris FD, Balfour HM, Bowen K, Farley J, Hardwick M, Lamontagne C, Lundy M, Syme A, West P. A Model to Guide Hospice Palliative Care. Ottawa, ON: Canadian Hospice Palliative Care Association, 2002.

    24. …Palliative Care… End-of-life /Hospice Care Therapies tomodify disease Palliative Care Presentation 6m Death Therapies to relieve suffering and / orimprove quality of life BereavementCare

    25. ...Palliative Care Help to • Eat well • Sleep well • Maintain function • Minimize stress • Live better • Live longer

    26. Needsof Patients / Families

    27. Processof ProvidingCare

    28. “ The Model… …is the most importantdocument in the history of hospice palliative care in Canada ” “ The Model is implicit in all hospice palliative care in Canada – it’s like the hard drive in every computer, invisible but supporting everything. ”

    29. CHPCA Model  Impact • Patient / family care • National Health Accord •  Access to medications for home PC • Education • Pallium • EFPPEC • Research • Canadian Institutes for Health Research

    30. 2012‘ One Voice ’

    31. 2012 National Guidelines

    32. The Challenge… 2012 - 2040, how will Sweden applythe Guidelines to  PC funding, skills & services…

    33. Human Rights Watch“ Pain & PC are Human Rights ” India Kenya Ukraine

    34. Unrelieved Pain is Medical Torture

    35. Call to Action… How will Sweden •Ensure PC human right •Include in health policy with funding - cancer, elders, all diagnoses

    36. WHO proposed:Opioid use is an indicator of PC capacity…

    37. Global Morphine-Equivalent Opioid Consumption,Pain Policy Studies Group, Madison, WI

    38. Swedenhas many medications & opioids for palliative care…and all medical uses…

    39. > 80 % of global morphine consumed by 7 countries with < 10 % of world’s population. Developing countries ( > 80% of world’s population ), consume < 10 % of global morphine 1. Austria 177Substitution Therapy 2. Canada 76.7 3. USA 74.4 14. Sweden 20 131 Countries < Global Mean 23 Countries > Global Mean

    40. 10. Sweden 20

    41. 1. USA 198 2. Canada 142 8. Sweden 31.5

    42. 5. Sweden 31.5

    43. Call to Action… How will Sweden increaseper capita opioid use ?

    44. Call to Action… How will Sweden avoid medication stock-outs ?

    45. Call to Action… Train ALL healthcare professionalsto provide palliative care…