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Integrated regional Palliative Care Services – supporting end of life care Options

Integrated regional Palliative Care Services – supporting end of life care Options. Dr Robin Fainsinger Professor & Director Division of Palliative Care Medicine University of Alberta Edmonton, Alberta Canada. Objectives. Describe integrated palliative care service options

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Integrated regional Palliative Care Services – supporting end of life care Options

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  1. Integrated regional Palliative Care Services – supporting end of life care Options Dr Robin Fainsinger Professor & Director Division of Palliative Care Medicine University of Alberta Edmonton, Alberta Canada

  2. Objectives • Describe integrated palliative care service options • Discuss results demonstrating end of life care outside of hospitals

  3. 65 year man with Ca Lung • Admitted to hospital with confusion • Given IM morphine for pain • Found to have Brain mets • Transferred for radiotherapy • Given IV morphine & IV hydration • Family want to take him home • Discharged without any discussion of home care plan or end of life care options

  4. Integrated PC ServicesExist across Canada

  5. 65 year man with Ca Lung • Admitted to hospital with confusion • Assessed by Palliative Care team & started on Sc morphine & hypodermoclysis for hydration • Found to have Brain mets • Transferred for radiotherapy • Assessed by PC team, Sc morphine & hypodermoclysis continued

  6. Family want to take him home • PC team contacts family physician & Palliative home care • Ongoing maintenance of Sc opioids & hydration by hypodermoclysis on return home • 3 weeks later admitted to Hospice PCU • Sc opioids & hypodermoclysis continued • Same clinical & psychosocial assessments at all points of care • Goals of care communicated across points of care

  7. Bruera et al Edmonton RPCP impact on patternsof terminal cancer care. CMAJ 1999;161:290 • Retrospective study comparing the patterns of care and sites of death before the RPCP (1992/1993) and 2nd year of operation (1996/1997) • Cancer related deaths in acute care facilities decreased from 86% in 1992/1993 to 49% in 1996/1997 • Inpatient days in acute care hospitals decreased from 24,566 to 6,960 over the same period

  8. Palliative Care Programs in Alberta Interdisciplinary Comprehensive Edmonton (July 1995) Calgary (October 1996) Integrated Coordinated

  9. Utilization & costs of the introduction of system-wide palliative care in Alberta, 1993-2000 • Fassbender K, Fainsinger RL, Brenneis et al Palliative Medicine 2005;19:513-520

  10. Figure 4: Probability of Referral to Palliative Care by Type of Service at Any Time in Last Year of Life, 1993/94 to 1999/00, n= 16,282. Referral to any palliative care service

  11. Location for the last 365 days before death(1999/00)n = 2549

  12. Fainsinger R, Brenneis C, Fassbender KEdmonton, Canada: A Regional Modelof Palliative Care DevelopmentJPSM 2007;33:634 • 27.8% of cancer patients die at home Location of death • 3.4% die in nursing homes • 28.9% of patients die in hospice • 40.0% die in acute care • 8.4% in the tertiary palliative care unit

  13. Patients spend 87.1% of their time at home in the last year of life - Location of Care • 3.5% of time is spent in nursing homes, • 2.4% of time is spent in hospice PCU • 8.1% is spent in acute care • Includes 0.6% in the tertiary palliative care unit

  14. P & EOL Care Achievements • Access & availability increased • Continuity of care/family physician involvement • Cost Neutral • Decreased hospital care days

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