Значення мультидисциплінарного, міжвідомчого і міжсекторального підходів як умов впровадження системи паліативної та хоспісної допомоги в Україні

Abstract

Purpose - to carry out medical and social analysis of conditions and organizational aspects of the Palliative and Hospice Care (PHC) System implementation and development in Ukraine. Materials and methods. There were analyzed: domestic and foreign scientific literary sources; data of official statistics of the State Statistics Service and the Ministry of Health of Ukraine; normative-legal documents of Ukraine and authoritative international professional organizations. Аnd the following research methods were applied: bibliosemantic, system approach and system analysis, comparative content analysis and generally accepted medical-statistical methods. Results. The peculiarities of the medical and demographic situation in Ukraine in recent decades are the rapid population aging, high morbidity and mortality from cancer and severe complications of chronic noncommunicable diseases, significant spread of HIV/AIDS, tuberculosis, viral hepatitis B and C etc. This requires the creation and improvement of an adequate regulatory framework (RF), which regulates the development of an accessible multidisciplinary, interagency and intersectoral PHC System, which requires the development of outpatient PHC services and inpatient PHC facilities, coordination of institutions and agencies subordinate to various ministries and agencies, first of all, the Ministry of Health of Ukraine and the Ministry of Social Policy of Ukraine; introduction of a system of motivation and training of PHC providers and involvement primary health care facilities medical staff in the palliative care provision at home. Thus, affordable and high-quality PHC should be integrated into the Health Care and Social Protection System, as PHC in the early stages of a life-threatening or incurable disease can significantly reduce suffering and improve the quality of life for both palliative patients (PPs) and their families. Conclusions. The urgency of the problem of creating and developing a System of affordable, high quality and effective PHC in Ukraine is due to the unfavorable medical and demographic situation - population aging, increasing morbidity and mortality from cancer and chronic diseases, often accompanied by chronic pain syndrom and other severe symptoms that significantly reduce the quality of life of PPs. The implementation of the PHC System for the population requires political support from the Government of Ukraine, Regional and Local Authorities, appropriate financial support and the whole society participation. Implementation and development of the PHC System in Ukraine with adequate funding from the State Budget (National Health Service of Ukraine), as well as through state, regional and local targeted PHC Programs will provide quality and effective multidisciplinary and interagency palliative care on equal terms, regardless of the nosology of the disease, PPs place of residence/stay and social status. The results of the study allowed to adapt international experience and identify different forms of PНC, which, depending on the severity of the disease and at the request of PPs and their families, can be provided in specialized inpatient PНC facilities, PНC departments of secondary and tertiary health care facilities or outpatient settings, including at home, as well as in PHC facilities of any form of ownership and departmental affiliation, subject to compliance with the standards and requirements of the RF. No conflict of interests was declared by the authors.