The Portuguese strategic plan for palliative care 2017-2018

Dr Edna Gonçalves, President of the Portuguese National Commission for Palliative Care, and her colleagues give a summary of the Portuguese Strategic Plan for the Development of Palliative Care 2017-2018.

Dr Edna Gonçalves

In Portugal, Palliative Care (PC) emerged in the early 1990s due to a few pioneers keen to treat suffering in patients with advanced stages of incurable diseases.The Portuguese Association for Palliative Care (PAPC) was founded in 1995 and in 2011 the 12thWorld Congress of the European Association for Palliative Care took place in Lisbon with more than 2,000 participants.

In June 2016, the Government of Portugal nominated the National Commission for Palliative Care (NCPC) to design a Strategic Plan for the Development of Palliative Care in 2017-2018 (SPDPC) and implement a functional PC network in Portugal, based on the 2012 Palliative Care Law. This law enshrines palliative care as a citizen’s right, under the supervision of the Ministry of Health.

Based on the World Health Organization (WHO) and European Association for Palliative Care (EAPC) recommendations, the NCPC proposed the full integration of the palliative care network into the Portuguese National Healthcare System (NHS), in all levels of care (primary health care, hospital health care and integrated continuous care).

Based on the methodology defined by Murtagh and Higginson the NCPC estimated that 71.500 to 85.000 patients need palliative care and recommended the following resources until the end of 2018:

  • Hospital Palliative Care Beds (HPCB): 40-50 beds per 1,000,000 inhabitants (total expected = 417 beds);
  • Home PC Teams (HPCT): 1 team per 100 000 to 150 000 inhabitants (total expected = 52 HPCT);
  • Hospital PC Support Teams (HPCST): 1 team per hospital.

The Portuguese Palliative Care Network – Organisational Model

What’s been achieved so far …  

Currently, all NHS hospitals in Portugal have an HPCST (n=43), which means an increase of 40 per cent of coverage compared to 2015 (n=26) and there are two Paediatric-HPCST. Eight HPCTs were created in the past two years, making a total of 20 teams. There are 382 PC beds, 213 in hospitals (14 units) and 169 beds in the National Network for Integrated Continuous Care (RNCCI), designed for less complex situations (14 RNCCI-PC units).

Several organisational changes, described below, have been implemented in the Portuguese PC network since June/2016

  • Palliative care teams must have, at least, a physician and a nurse with advanced training, a social worker and a psychologist with training in PC (minimum of hours per professional is required). All professionals write in the same electronic clinical system that can be accessed by NHS healthcare professionals.
  • The PC units were restructured considering the two levels of care described above (HPCB and RNCCI-PC units).
  • There is a health normative on essential medication for the HPCT and non-fees are applicable to PC patients in the NHS.
  • The NCPC designed and provided intermediate training on PC (90 hours) to primary care and RNCCI professionals, funded by the NHS.
  • Several protocols were signed between the Ministry of Health and Schools of Medicine, Nursing, Psychology and Social Work to introduce PC in the undergraduate curriculum.

Who we are …

To ensure that the resources and polices developed are appropriate to the different needs of patients and the complexity of specialist PC teams, the NCPC has gathered together healthcare professionals from the four disciplines included in the Basic PC teams in Portugal

Board members Regional Coordinators (Physicians)
Edna Gonçalves (Chair) – Physician North area:  José Miguel Lopes
Carla Reigada, Social Worker and  Researcher Centre area: Isabel Duque Martins
Fátima Teixeira, Physician Lisbon and Tagus valley area: Ana Cristina Fryxell
Helena Salazar, Psychologist Alentejo area: Margarida Damas de Carvalho
Ricardo Silva, Nurse Algarve area: Fátima Teixeira

 Our goals for the near future are to:

  • Have an HPCT in each Health Centre Group, the primary healthcare providers in the Portuguese NHS (n= 52).
  • Implement PC services with PCU, HPCST and Outpatient clinic in all university NHS hospitals and oncologic institutes.
  • Work with professional associations to define a PC specialists’ profile.
  • Establish criteria for monitoring, certifying, and accrediting PC teams.
  • Promote cooperation between specialist PC teams and national and international research centres.

References

  1. Neto, Isabel Galriça; Marques, António Lourenço; Gonçalves, Edna; et al. Palliative care development is well under way in Portugal. European Journal of Palliative Care. [Online] 2010.
  2. Murtagh, Fliss EM; Bausewein, Claudia; Verne, Julia; et al. How many people need palliative care? A study developing and comparing methods for population-based estimates. Palliative Medicine. [Online] 2014.

Links

 

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