The experience of the "Program of palliative care in an outpatient setting in the Dnipro City for 2018-2021" implementation: the problems and prospects

Abstract

Background. Many Ukrainian authors noted that an innovative System of Palliative and Hospice Care (PHC) and Social Services for Palliative Care (SSPC) the creation and implementation are the most important medical and social tasks of the Government and society in Ukraine today which appreciate the civilization and humanity of our state and society. PHC are a modern patient-family-oriented humanitarian approach that contributes to the preservation of the human dignity of palliative care patients (PCP) and can ensure the proper quality of life of PCP and their relatives. According to the WHO and the Council of Europe Committee of Ministers Recommendations, palliative care should be one of the priorities of the Health Care Government Policy in the European region. The purpose of the study: the "Program of palliative care in an outpatient setting in Dnipro City for 2018-2021" the implementation analysis. Materials and methods. The work used national and international legal documents and literature sources, data from medical statistics, methods of systemic and structural-functional analysis, bibliosemantic and statistical research methods. Results. The international and national legal documents and scientific literature a content analysis showed that in accordance with modern approaches and standards, PHC is provided taking into account the PCP and its family members needs, wishes and consent, depending on medical, demographic, socio-economic and cultural ethnic features of the region. A comparative analysis of the PHC state in Ukraine and Dnipro City showed some regional features, in particular, the significant need to provide PHC and SSPC to patients at home and the need and ensure a mechanism of cooperation between primary health care physicians, inpatient health care and social care institutions to develop. In 2017, the “Program of outpatient palliative care in Dnipro City for 2018–2021” (hereinafter - the Program) was developed and approved at the City Council session, which allowed the PHC and SSPC multidisciplinary and interagency approaches implementation, effective interdepartmental coordination, cooperation and the continuity of PHC and SSPC to ensure. The Multidisciplinary Mobil Specialized Palliative Care Team has been working in close contact with family doctors and social workers in the city since June 2019. As part of the Program, PCP are provided with medicines, technical and other means of care and rehabilitation free of charge or on preferential terms. In addition, the Palliative Care Team provides PCP, if indicated, oxygen concentrators and anti-decubitus mattresses. The Program creates points for renting medical care for PCP (wheelchairs, walkers, anti-decubitus mattresses, crutches, etc.), as well as providing patients with medical care at home (urine and feces, diapers, etc.). In 2020, UAH 300,000 was allocated from the Program budget for the Palliative Care Team with medical equipment, medicines and rehabilitation technical means complete set. In total, it is planned to allocate over UAH 40 million from the Dnipro City Budget for the Program implementation. Conclusions. 1. Thus, today in Dnipro City the Comprehensive Palliative Care System at home is implemented due to co-financing from the State Budget and due to the "Program of palliative care in outpatient conditions in Dnipro City for 2018-2021", approved by the Dnipro City Council the deputies. 2. An important condition for comprehensive provision of the Dnipro City population needs in PHC and SSPC is the Dnipro City Council support to create a modern accessible, high-quality and efficient PHC and SSPC service, which an effective interagency coordination, continuity and cooperation between health care providers and social care institutions provides, Multidisciplinary Mobil Specialized Palliative Care Team creation and development of in each the city district, the coordination and continuity of inpatient PHC in the city health provides. 3. There is both the Government support and municipal or regional budgets support for PHC Programs in many developed countries. The international PHC standards and experience implementation can significantly the provision of needs and the quality of life of both PCP and their families improve.