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Palliative Care Policy Development Hotel Rege, Budapest, Hungary October 16, 2003

The Austrian Experience. Dr. Johann BAUMGARTNER, MD Coordination Palliative Care Styria johann.baumgartner@kages.at Styria, Graz. Palliative Care Policy Development Hotel Rege, Budapest, Hungary October 16, 2003. Content Facts Some Steps Highlights The way forward.

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Palliative Care Policy Development Hotel Rege, Budapest, Hungary October 16, 2003

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  1. The Austrian Experience Dr. Johann BAUMGARTNER, MD Coordination Palliative Care Styria johann.baumgartner@kages.at Styria, Graz Palliative Care Policy Development Hotel Rege, Budapest, Hungary October 16, 2003

  2. Content • Facts • Some Steps • Highlights • The way forward

  3. Facts about Austria • 84.000 square kilometers • 9 provinces • 8,1 million inhabitants • social demographicdevelopment: • increase of elderly • decrease of births

  4. Responsibilities in the health care system • Ministries of federal goverment: - social insurance law - basic principles in health care - education for medical professionals • Provinces and communities: - implementation and execution of laws - providing hospital care • Social security institutions

  5. Characteristics of the healthcare system • compulsory health insurance (> 99% coverage) • 34.593 physicians 1:231 inhabitants (2000) • 70.261 beds in 321 hospitals 1:115 inhabitants(2000) • 68.033 places in 761 nursing homes 1:119 inhabitants(2001) • ambulatory specialist outpatient care from “Public Health”, Ministry for social Security and Generations, Vienna 2001

  6. Number and places of death

  7. Wishes of patients in Austria • 81 % want to die at home • 75 % want to die “suddenly and quickly“ • 83 % want to die without pain • 92 % want to know the „truth“ Zulehner, 2001

  8. History • influences from Great Britain and Germany • Book: “On Death and Dying” • Film: “Still 16 days!” • individual activities • rise of volunteers and community programs

  9. „Hospice steps“ Hospice teams (volunteers) • 1989: Vienna • 1993: Innsbruck, Graz, Baden, Mödling • 1994/95: Linz, Vorarlberg, Salzburg • 1996/97: St.Pölten, Carinthia Burgenland

  10. „Palliative Care Steps“ • 1989: 1st home support team (Vienna) • 1992: 1st palliative care unit (Vienna) • 1998: 1st interdisciplinary palliative care course (Vienna) • 1999: 1st hospital support team (Linz) • 2000: 1st day hospice (Salzburg) • 2000: 1st home support team for children (Vienna)

  11. NATIONAL ORGANIZATIONS • Hospice Austriawww.hospiz.atumbrella organisation of hospice and palliative care services (1993) • public relations, lobbying • interdisciplinary courses • directory of services • standards

  12. NATIONAL ORGANIZATIONS • Austrian Palliative Care Association OPG (2000) www.palliativ.atScientific oriented, lobbying • Courses for physicians and nurses

  13. Highlight 1992 • Enquete in the Austrian parliament:„Dying in Austria“ first official awareness of the problem

  14. Highlight 1997 • Education of nurses:Integration of palliative care into the undergraduate education of registered nurses: • 60 hours during 3 years (GUKKG 1997 )

  15. Highlight 2000 • Adoption of palliative care into thenational plan for acute care hospitals (ÖKAP/GGT 2000) • plan until 2005:30 palliative care units (274 beds) • financial regulation (LKF-system) • quality criteria for staffing and equipment

  16. Highlight 2001 • Declaration of all 4 political parties in the Austrian Parliament 2001 May against Euthanasia 2001 Dec. for Palliative Care

  17. Highlight 2002 • Family Hospice Leave (Familienhospizkarenz) legal claim for reduction/exemption from work for the care for their dying family members • 1 week - 6 months • social assurance is paid • no salary

  18. Highlight 2003 • Palliative Care Programme Medical University Graz University hospital • inpatient unit: 12 beds • hospital support team • home support team • education • research

  19. Inpatient Hospice Inpatient Unit Home Support Team Hospital Support Team Volunteers hospital at home nursing homes Levels of Palliative Care Day Hospice 1 At home

  20. Inpatient Palliative Care

  21. Inpatient Palliative Care Units Inpatient Hospices Austria 2003

  22. Support Teams and Day Hospices

  23. Hospital Support teams Home Support Teams Day Hospices Austria 2003

  24. Funding sources • acute care setting - PCU: hospital funds • Specialist palliative care services in all other services -mixed funding: • patients and familymembers • social assurance • Provinces • charity Urgent need for further regulations!

  25. Education - undergraduate Baumgartner J., A. Gigl; Mobile Palliativbetreuung, ULIG, Graz (2001)

  26. Education – postgraduate Diploma „Palliative Medicine“ Austrian Medical Association 2002 • 18 interdisciplinary courses since 1998 participants: 610 • 5 courses for physicians since 1999 participants : 145 • 5 courses for registered nurses since 2000 participants : 90

  27. High level: MASTER Palliative Care Interdisciplinary Course - 170 units + 80 u. practice Medium level: EXPERT Palliative Care Interdisciplinary Course -140 u. Interdisci- plinary Course „Expert“315 u. Profession specific courses–140 u.+40 u.pr. Medicine Nursing Psycho-social-spiritual Basic level: DIPLOMA Palliative Care Interdisciplinary Course Palliative Care - 140 u.+ 40 u. pr. Vienna Salzburg Upper Austria Vorarlberg Lower Austria others Advisory Board Lead: Faculty of Medicine Education – postgraduate

  28. DECLARATION Government 2003 - 2006 „The human quality of our society can be measured, how we care for people in the last time of their lives. There should be sufficient facilities for hospice care, for all those who need it.“ Chancellor Dr. W. SCHÜSSEL, 6th March 2003, p. 25 http://www.austria.gv.at/regierungserklaerung.pdf

  29. Recommendations National Accounting Office • The implementation of Hospital and HomeSupport Teams should have priority • Ensure access and networking in the field of Palliative Care • The development of Palliative Care needs coordination and administration • Rechnungshof Zl 001.506/111-E1/03, Vienna, April 2003 http://www.rechnungshof.gv.at/

  30. Future needs • ensure access on all levels of care • integration of the specialist services into the health care system • resource allocation – national and federal • national strategy and federal plans • education, training and research • bereavement services • public awareness Hospice Austria

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