Abstract
Ecuador assumed the commitment of including Palliative Care (PC) in its health policies. In 2014, the Ministry of Public Health (Ministerio de Salud Pública, MSP) approved the Clinical Practice Guide for Palliative Care (Guía de Práctica Clínica sobre Cuidados Paliativos, GPCCP), with application at the national level, as a mandatory internal regulation in all institutions belonging to the National Health System. In 2021, there is no evidence about the degree of implementation. The objective was to evaluate the implementation (I) of the GPCCP guide and the knowledge (C) of the health personnel working in the Zone 7 Health Centers (HCs). This is a cross-sectional, descriptive, and prospective study. A total of 292 professionals were interviewed: managers (38), physicians (150), and nurses (104). Three surveys based on the GPCCP guide were elaborated: one for the implementation, which was applied to the individuals in charge, and the others to assess the health professionals’ knowledge. The SPSS program was used, version 25. In the three groups, more than half of the participants had no training in PC, 91.2% of the HCs have the GPCCP guide, there is PC medical history (MH) in 38.2%, and morphine is used in 14.7%. The implementation of the GPCCP guide was inadequate in 52.9% of the cases. Only 25% treat the agony symptoms and 30%, delirium; 4.4% acknowledge the use of morphine in dyspnea, and 13.3% identify the subcutaneous route as the first choice for hydration at the end-of-life phase. Strategies to implement the GPCCP guide and to improve the health personnel’s knowledge must be implemented in Zone 7 centers.
Highlights
The total population of this zone is 1,341,334 inhabitants who receive care, some in MSP health units and others in units from the public health network such as the different health centers belonging to the various social insurance systems in the country
2015–2017 Palliative Care National Plan, where all health establishments are compelled to apply it, which does not necessarily lead to putting it into practice to ensure provision of the service. This phenomenon has been observed in several studies [12,13] and, perhaps, the most notorious is the one by the World Health Organization (WHO) in 2015, which concludes that, in order to have successful Palliative Care programs, universal access to the essential palliative care (PC) medications is required, as well as generalized education and implementation, in line with the results found in this study
The health professionals possess insufficient knowledge about PC and limited professional experience. They acknowledge that they do not feel trained in the diagnosis and management of PC urgencies, in the use of morphine for pain treatment, and in its secondary effects
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. The view of palliative care (PC) in the world has changed over the years. It is acknowledged that it relieves suffering, controls symptoms, and improves quality of life and care quality [1]. Comprehensive care for patients with diseases that restrict life during their evolution offers an effective outcome–cost ratio for the patient, the family, and the health systems [2]
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