Dr Mirko Riolfi, Palliative Care Unit, Local Health Authority No. 5, Veneto Region, Italy, explains the background to a longer article that is published in this month’s Palliative Medicine.
We are delighted that our article was nominated as ‘Editor’s Choice’ for the May 2014 edition of Palliative Medicine. 1
In Italy, every region must provide a nationally defined basic health benefit package to all of its citizens. In each of the 20 regions, Local Health Authorities (LHAs) are responsible for the delivery of primary care to a geographically designated population. The LHA No. 5 in the Veneto Region (north-east of Italy) serves a population of 179,783. In 2011, LHA No. 5 set up a Palliative Home Care Team (PHCT), in accordance with Regional Law No. 7 (19/03/2009) and the Italian Law No. 38 (5/04/2010).
These laws ratify the rights of terminally ill patients to access specialist palliative care services. Our palliative home care team consists of two palliative care physicians and 30 non-specialist nurses who co-operate with general practitioners (GPs). At least one specialist palliative care medical examination a week is guaranteed for all terminally ill patients being cared for at home, and this specialist medical examination is conducted daily in the last days of life. At night and weekends, patients, caregivers and colleagues can always contact our palliative care physicians by ‘phone. Usually there’s also good co-operation with the 105 GPs of our LHA.
The first year of activity was in 2011, so this is quite a new health service. Our initial motivation for this study was to understand how well (or not) we were working and, at the same time, to promote palliative care and create a culture about this approach. We enrolled in the study all patients listed by LHA No. 5 as dying of cancer in 2011. Then we measured inpatient death and days of hospitalisation in the last two months of life, comparing people supported by the PHCT with those who had not been referred. We also tried to identify factors predicting the likelihood of patients treated at home being admitted to the unit.
A palliative care approach into the continuum of care of chronic life-threatening illnesses can improve the quality of life of patients and their family. The goal of palliative care is to enable patients to die at their preferred place of death in the best possible conditions, and the literature consistently demonstrates that the majority of terminally ill patients would prefer to stay and die at home.
Our study results confirmed that patients referred to the PHCT were more likely to die at home, less likely to be hospitalised, and spent fewer days in hospital in the last two months of their life. This approach produces a positive economic ‘side effect’ by reducing unnecessary hospitalisations and inappropriate use of healthcare services. We live in a time of spending reviews and our local health authorities are required to keep the same level of health services with less funding. In this context, the integration of palliative care into existing healthcare services could lead to a more sustainable public health approach.
Our PHCT is ‘young’ and there’s a lot to do to improve care for patients and their relatives in our service, but I hope that our study can be useful to others in their work.
Finally, I would like to thank all team members that made this study possible and colleagues of the Italian Society of Palliative Care (SICP) for their kindness every time we need suggestions about clinical and organisational problems. SICP’s 21st National Congress takes place in Arezzo (Italy) on 9-12 October – it’s a great opportunity to be updated and meet expert colleagues. I hope I will see you there!
1. Mirko Riolfi, Alessandra Buja, Chiara Zanardo, Chiara Francesca Marangon, Pietro Manno, and Vincenzo Baldo. Effectiveness of palliative home-care services in reducing hospital admissions and determinants of hospitalization for terminally ill patients followed up by a palliative home-care team: A retrospective cohort study. Palliat Med 2014, 28(5): 403-411, first published on December 23, 2013 doi:10.1177/0269216313517283.
Download a free copy of the full article…
This post relates to the longer article cited above. EAPC members and registered users of the EAPC website can download a free copy of this article and other ‘Editor’s choice’ papers from the EAPC website. (You may need to register or login to download the paper; just follow the instructions in the top right-hand corner of EAPC home page to register or login, and scroll down to download the article). Click here to view other EAPC-originated papers on the EAPC website.
Find out more…
There’s information on the SICP congress and other international courses and conferences in the EAPC ‘Events Calendar’.
Click here for information on the Italian and Veneto Region laws about palliative care (follow links to ‘Legislation page’).
Are you coming to Lleida?…
Ci vediamo al 8 ° Congresso Mondiale EAPC della Ricerca che si terrà in Lleida (Spagna) dal 5 al 7 giugno 2014. Seguici on Twitter – il hashtag ufficiale del congresso è #eapc2014
See you at the 8th EAPC World Research Congress in Lleida, Spain. 5-7 June 2014. Follow us on Twitter @EAPCOnlus – our official congress hashtag is #eapc2014