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Open Access 01-12-2016 | Research article

Identification and characteristics of patients with palliative care needs in Brazilian primary care

Authors: Fernando C. I. Marcucci, Marcos A. S. Cabrera, Anamaria Baquero Perilla, Marilia Maroneze Brun, Eder Marcos L. de Barros, Vanessa M. Martins, John P. Rosenberg, Patsy Yates

Published in: BMC Palliative Care | Issue 1/2016

Abstract

Background

The Brazilian healthcare system offers universal coverage but lacks information about how patients with PC needs are serviced by its primary care program, Estratégia Saúde da Família (ESF).

Methods

Cross-sectional study in community settings. Patients in ESF program were screened using a Palliative Care Screening Tool (PCST). Included patients were assessed with Karnofsky Performance Scale (KPS), Edmonton Symptom Assessment System (ESAS) and Palliative Care Outcome Scale (POS).

Results

Patients with PC needs are accessing the ESF program regardless of there being no specific PC support provided. From 238 patients identified, 73 (43 women, 30 men) were identified as having a need for PC, and the mean age was 77.18 (95 % Confidence Interval = ±2,78) years, with non-malignant neurologic conditions, such as dementia and cerebrovascular diseases, being the most common (53 % of all patients). Chronic conditions (2 or more years) were found in 70 % of these patients, with 71 % scoring 50 or less points in the KPS. Overall symptom intensity was low, with the exception of some cases with moderate and high score, and POS average score was 14.16 points (minimum = 4; maximum = 28). Most patients received medication and professional support through the primary care units, but limitations of services were identified, including lack of home visits and limited multi-professional approaches.

Conclusion

Patients with PC needs were identified in ESF program. Basic health care support is provided but there is a lack of attention to some specific needs. PC policies and professional training should be implemented to improve this area.

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World Health Organization. WHO: The global burden of disease. Switzerland: World Health Organization; 2004. http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/.

Gómez-Batiste X, Martínez-Muñoz M, Blay C, Espinosa J, Contel JC, Ledesma A. Identifying needs and improving palliative care of chronically ill patients: a community-oriented, population-based, public-health approach. Curr Opin Support Palliat Care. 2012;6(3):371–8. doi:10.1097/SPC.0b013e328356aaed. Available from: http://journals.lww.com/co-supportiveandpalliativecare/Fulltext/2012/09000/Identifying_needs_and_improving_palliative_care_of.13.aspx.CrossRefPubMed

WHO. Sixty-seventh World Health Assembly. Resolutions and Decisions..19–24 May 2014. Geneva: WHO; 2014.

Pastrana T, De Lima L, Wenk R, Eisenchlas J, Monti C, Rocafort J, et al. Atlas of Palliative Care in Latin America - ALCP. Houston: IAHPC Press; 2012.

Worldwide Palliative Care Alliance. WPCA. Global Atlas of Palliative Care at the End of Life. 2014. Available from: http://www.thewpca.org/resources/global-atlas-of-palliative-care/.

Marcucci FCI, Cabrera MAS. Death in hospital and at home: population and health policy influences in Londrina, State of Paraná, Brazil (1996–2010). Cien Saude Colet. 2015;20:833–40. Available from: http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1413-81232015000300833&nrm=iso.CrossRefPubMed

The Economist Intelligence Unit. The 2015 Quality of Death Index - Ranking palliative care across the world. 2015.

Macinko J, Dourado I, Aquino R, Bonolo PF, Lima-Costa MF, Medina MG, et al. Major Expansion Of Primary Care In Brazil Linked To Decline In Unnecessary Hospitalization. Health Aff. 2010;29(12):2149–60. Available from: http://content.healthaffairs.org/content/29/12/2149.abstract.CrossRef

Combinato DS, Martins STF. (Em defesa dos) Cuidados Paliativos na Atenção Primária à Saúde. O Mundo da Saúde. 2012;36(3):433–41.

10.

Valente SH, Teixeira MB. Estudo fenomenológico sobre a visita domiciliária do enfermeiro à família no processo de terminalidade. Rev esc enferm USP. 2009;43(3):655–61. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0080-62342009000300022&lng=pt&nrm=iso.CrossRefPubMed

11.

Grbich C, Maddocks I, Parker D, Brown M, Willis E, Piller N, et al. Identification of patients with noncancer diseases for palliative care services. Palliat Support Care. 2005;3(01):5–14. Available from: http://dx.doi.org/10.1017/S1478951505050029.CrossRefPubMed

12.

Boyd K, Murray SA. Recognising and managing key transitions in end of life care. BMJ. 2010. doi:10.1136/bmj.c4863.PubMedCentral

13.

Center to Advance Palliative Care. CAPC: Crosswalk of JCAHO Standards and Palliative Care — Policies, Procedures and Assessment Tools. 2007. http://www.palliativedrugs.com/download/JCAHO-crosswalk.pdf: 13 Jan 2013.

14.

Van Mechelen W, Aertgeerts B, De Ceulaer K, Thoonsen B, Vermandere M, Warmenhoven F, et al. Defining the palliative care patient: A systematic review. Palliat Med. 2013;27(3):197–208. Available from: http://pmj.sagepub.com/content/27/3/197.abstract. [cited March 1, 2013].CrossRefPubMed

15.

Lucchetti G, Badan Neto AM, Ramos SAC. Uso de uma escala de triagem para cuidados paliativos nos idosos de uma instituição de longa permanência. Geriatr Gerontol. 2009;3(3):104–8.

16.

ANCP. Academia Nacional de Cuidados Paliativos. Manual de cuidados paliativos. Rio de Janeiro: Diagraphic; 2009. 320 p.

17.

Palliative Care Outcome Scale. Cicely Saunders Institute, King’s College London. What is POS, Versions. London: POS; 2015. Available from: pos-pal.org/maix/versions.php.

18.

Gómez-Batiste X, Martínez-Muñoz M, Blay C, Amblàs J, Vila L, Costa X, et al. Prevalence and characteristics of patients with advanced chronic conditions in need of palliative care in the general population: A cross-sectional study. Palliat Med. 2014;28(4):302–11. Available from: http://pmj.sagepub.com/content/28/4/302.abstract. [cited April 1, 2014].CrossRefPubMed

19.

UNDP. United Nations Development Programme: Human Development Report 2014 - BRAZIL. New York: UNDP; 2014. http://hdr.undp.org/sites/all/themes/hdr_theme/country-notes/BRA.pdf: 09 Sep. 2015.CrossRef

20.

Brasil: Ministério da Saúde. Portaria n° 2.439/GM de 8 de dezembro de 2005. Institui a Politica Nacional de Atenção Oncológica: Promoção, Prevenção, Diagnóstico, Reabilitação e Cuidados Paliativos, a ser implantada em todas as unidades federadas, respeitadas as competências das três esferas de gestão: Brasília: 2005

21.

Brasil: Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Política Nacional de Atenção Básica [En: National Polices of < Health > Basic Attention]: Brasília: 2012: http://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_atencao_basica.pdf: 20 Sept. 2015

22.

Corrêa SR, Mazuko C, Almeida M, Sassi RM, Murray SA, Wenk R, et al. OA59 Developing an innovative model of palliative care in the community in brazil. BMJ Support Palliat Care. 2015;5 Suppl 1:A19. Available from: http://spcare.bmj.com/content/5/Suppl_1/A19.1.abstract. [cited April 1, 2015].CrossRefPubMed

23.

Bertoldi AD, de Barros AJD, Wagner A, Ross-Degnan D, Hallal PC. Medicine access and utilization in a population covered by primary health care in Brazil. Health Pol. 2009;89(3):295–302. Available from: http://www.sciencedirect.com/science/article/pii/S0168851008001619.CrossRef

24.

Brumley R, Enguidanos S, Jamison P, Seitz R, Morgenstern N, Saito S, et al. Increased Satisfaction with Care and Lower Costs: Results of a Randomized Trial of In-Home Palliative Care. J Am Geriatr Soc. 2007;55(7):993–1000. Available from: http://dx.doi.org/10.1111/j.1532-5415.2007.01234.x.CrossRefPubMed

25.

Pham B, Krahn M. End-of-life care interventions: an economic analysis. Ont Health Technol Assess Ser. 2014;14(18):1–70. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4552298/. [cited 2014 December].

26.

Smith S, Brick A, O’Hara S, Normand C. Evidence on the cost and cost-effectiveness of palliative care: A literature review. Palliative Med. 2014;28(2):130–50. Available from: http://pmj.sagepub.com/content/28/2/130.abstract. [cited February 1, 2014].CrossRef

27.

Dourado I, Oliveira VB, Aquino R, Bonolo P, Lima-Costa MF, Medina MG, et al. Trends in Primary Health Care-sensitive Conditions in Brazil: The Role of the Family Health Program (Project ICSAP-Brazil). Med Care. 2011;49(6):577–84. Available from: http://journals.lww.com/lww-medicalcare/Fulltext/2011/06000/Trends_in_Primary_Health_Care_sensitive_Conditions.8.aspx.CrossRefPubMed

28.

Mendonça CS, Harzheim E, Duncan BB, Nunes LN, Leyh W. Trends in hospitalizations for primary care sensitive conditions following the implementation of Family Health Teams in Belo Horizonte, Brazil. Health Policy Plan. 2012;27(4):348–55. Available from: http://heapol.oxfordjournals.org/content/27/4/348.abstract. [cited July 1, 2012].CrossRefPubMed

29.

Villas Boas MLDC, Shimizu HE, Sanchez MN. Clinical and epidemiological profile of patients from the home care program of Federal District Brazil. J Pub Health Epidemiol. 2015;7(6):189–97. Available from: http://www.academicjournals.org/journal/JPHE/article-full-text-pdf/F4ACAA453431.CrossRef

30.

Brasil: Ministério da Saúde. Portaria n° 1.208 de 18 de junho de 2013. Dispõe sobre a integração do Programa Melhor em Casa (Atenção Domiciliar no âmbito do SUS) com o Programa SOS Emergências, ambos inseridos na Rede de Atenção às Urgências: Brasília: 2013:

31.

Chi NC, Demiris G, Lewis FM, Walker AJ, Langer SL. Behavioral and Educational Interventions to Support Family Caregivers in End-of-Life Care: A Systematic Review. Am J Hosp Palliat Med. 2015. doi:10.1177/1049909115593938. Available from: http://ajh.sagepub.com/content/early/2015/07/07/1049909115593938.abstract. [cited July 7, 2015].

Title: Identification and characteristics of patients with palliative care needs in Brazilian primary care
Authors: Fernando C. I. Marcucci
Marcos A. S. Cabrera
Anamaria Baquero Perilla
Marilia Maroneze Brun
Eder Marcos L. de Barros
Vanessa M. Martins
John P. Rosenberg
Patsy Yates
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Palliative Care / Issue 1/2016
Electronic ISSN: 1472-684X
DOI: https://doi.org/10.1186/s12904-016-0125-4

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Identification and characteristics of patients with palliative care needs in Brazilian primary care

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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