Identifying patients for palliative care in primary care in Brazil: Project Estar ao Seu Lado’s experience

Abstract

Identificando pacientes para cuidados paliativos na atenção primária no Brasil: experiência do Projeto Estar ao Seu Lado Objetivo: Apresentar o processo de identificação de pacientes de cuidados paliativos em uma equipe de Estratégia de Saúde da Família no Brasil. Métodos: O processo de identificação ocorreu 1) utilizando o sistema de trabalho de uma Equipe de Estratégia de Saúde da Família e os princípios da atenção primária e 2) aplicando o SPICT, uma ferramenta para ajudar a identificar pacientes que poderiam se beneficiar com cuidados paliativos. Resultados: Vinte e três pacientes foram inscritos no programa de cuidados paliativos no início do projeto. Ao final do período de 12 meses, identificamos 38 pacientes. Seis pacientes morreram durante o período. Assim, durante 2015, 38 pessoas foram identificadas com necessidades paliativas de uma população total de 3.000 (1,2% da população de prática). Destes, 58% (n=22) foram mulheres, 63% (n=24) com mais de 65 anos, 74,7% (n=28) relataram etnia branca. Os diagnósticos principais mais frequentes foram câncer (39,5%), doença psiquiátrica (18,4%), doença cardiovascular (15,8%), fraqueza (10,5%), demência (10,5%) e doença respiratória (7,9%). A multimorbidade foi maior em pacientes com mais de 65 anos (t-test, p=0,009) com uma mediana de quatro doenças. As patologias mais prevalentes entre os que sofrem de multimorbilidade foram doença cardiovascular (73,7%), doença psiquiátrica (65,8%), câncer (50%), fragilidade (39,5%), diabetes mellitus (31,6%) e doenças respiratórias (23,7%). Conclusão: Aplicamos uma ferramenta para identificar e gerenciar pacientes que se beneficiariam dos cuidados paliativos na atenção primária em Rio Grande. Sua aplicação é prática e viável. Seu aperfeiçoamento, implementação e avaliação no Brasil é indicado nos centros comunitários de Estratégia de Saúde da Família, levando em conta especificamente fatores sociais e econômicos desse país. Identificando pacientes para cuidados paliativos en atención primaria en Brasil: la experiencia del Proyecto Estar ao Seu LadoObjective: To present the process of identification of palliative care patients in a Family Health Strategy´s team in Brazil. Methods: The identification process ocurred 1) using the system of work of a Family Health Strategy Team and the principles of primary care and 2) by applying the SPICT, a tool to help identify patients who might benefit with palliative care. Results: Twenty-three patients were enrolled in the palliative care program at the beginning of the project. By the end of the 12 month period, we had identified 38 patients. Six patients died during the time period. Thus during 2015, 38 people were identified with palliative needs from a total population of 3,000 (1.2% of the practice population). Of these 58% (n=22) were women, 63% (n=24) over 65 years, 74.7% (n=28) reported white ethnicity. The most frequent major diagnoses were cancer (39.5%), psychiatric disease (18.4%), cardiovascular disease (15.8%), frailty (10.5%), dementia (10.5%), and respiratory disease (7.9%)...

Palliative care in primary health care: scoping review

“…In the research, a total of 154 studies were found, publications (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) were relevant for this review, since they met the study question and pre-established criteria, as explained in the analysis flowchart ( Figure 1).…”

“…With regard to language, eleven studies analyzed were published in Portuguese (9)(10)(11)(18)(19)(20)(21)(23)(24)(25)(26) and from Brazilian authors, five were published in Spanish (12)(13)(15)(16)(17) and three in English (14,16,22) . Of the included studies, eight (9)(10)(11)(17)(18)(19)(20)(21) used the qualitative approach and ten, the quantitative (12)(13)(14)(15)(16)(22)(23)(24)(25)(26) . As for the instruments / techniques for data collection/production, questionnaires, interviews, observation, discussion groups and application of scales were used.…”

“…Interface between social support, quality of life and depression in users eligible for palliative care (25) Revista The context of the studies was variable. Several experiences were found, such as: in daily life and patient care at home (9,19) ; meaning of being a caregiver and on PC (10,11) for health professionals; evaluation of tumor asthenia (12) ; validation and application of a tool for prognosis (13) ; identification and characterization of patients in PC and services (14,22,24,26) ; pain evaluation (15) ; assessment of dignity at the end of life (16) ; difficulties in accessing PCs (17) ; the work process in PHC (18) ; perspectives of occupational therapists in PC in PHC (20) ; ethical problems (21) ; comfort of caregivers of patients in PC (23) ; relationship between social support, quality of life and depression in PC patients in PHC (25) (Figure 3).…”

Palliative care: training the primary care workforce is more important than rebranding

“…Our second editorial drew responses from family doctors around the world, saying that primary palliative care had a major role in palliative care delivery and strategy. Brazil is progressing rapidly in this field owing to a strong primary care programme 4. In Colorado, USA, the primary care system has service and policy barriers but strong advocates for palliative care 5.…”

Why Brazil needs an umbrella urgently: about the challenges of public health model of palliative care and the use of available resources

“…There is not a specific agenda or program for palliative care from the National Program of Primary Care called Family Health Strategy, despite its 43,000 active teams distributed around the country 10 covering over 60% of the population (around 168 million). Very few community centers provide systematic palliative care, too 11 , and there is no integrated network that supports and follows patients when identified as needing palliative care figure 1.…”