The Catalonia World Health Organization Demonstration Project for Palliative Care Implementation: Quantitative and Qualitative Results at 20 Years

Abstract

Catalonia (Spain) has a total population of 7.3 million citizens for whom the National Health Service (NHS) provides health care that is free at the point of access. The prevalence of terminally ill patients is between 30,100 and 39,600. Twenty years ago, the World Health Organization (WHO), in collaboration with the Catalan Department of Health and the Catalan Institute of Oncology, began a demonstration project (WHO Demonstration Project) in palliative care (PC) with the aim of implementing specialist PC services, generating experience in this field, identifying areas for improvement, and introducing educative procedures (clinical and nonclinical). Over the past 20 years, 237 PC clinical services (72 home care support teams, 49 hospital support teams, 60 units with 742 dedicated beds, 50 outpatient clinics, and six psychosocial support teams) have been implemented. In the five years since the previous evaluation, 57 new clinical services (15 new hospital support teams, 36 outpatient clinics, and six psychosocial support teams among others) and four nonclinical services (education, research, WHO Collaborating Center, and planning) have been implemented. During the year 2010, a total of 46,200 processes were undertaken for the care of 23,100 patients, of whom 12,100 (52%) had cancer and 11,000 (48%) had other chronic advanced diseases. The overall yearly costs are around €52,568,000, with an overall savings of €69,300,000 (€2275 per patient, net savings to the NHS of €16,732,000). In the last five years, three qualitative evaluations and a benchmarking process have been performed to identify weak points and inequities in care provision among districts. Systematic assessments indicate high cost-effectiveness of care as well as high levels of satisfaction by patients and their relatives, thus reinforcing the principle that access to PC under the auspices of the NHS at the end of life is a basic human right.

Place of death in the population dying from diseases indicative of palliative care need: a cross-national population-level study in 14 countries

“…Furthermore, the data for Spain (only the Andalusia region) and Canada (excluding the Quebec province) may not be generalisable to the whole country. For instance, the Spanish autonomous community of Catalonia has been undertaking an extensive palliative care programme over the past years which could affect the place of death patterns 39. Although we tried to obtain healthcare supply data that were as similar between countries as possible, there is a certain level of heterogeneity that was unavoidable due to differences between countries in the ecological levels of the data linked to the individual death certificates and potential differences in the terminology regarding healthcare resources.…”

Palliative Care for the Seriously Ill

“…Many randomized, controlled trials and case–control studies of palliative care interventions to date have shown reductions in patients’ symptoms and health care utilization and improvements in quality of life and family satisfaction across a wide spectrum of populations, including patients with advanced cancer, 37 neurologic disease, 48 or lung disease 42 and older adults with multiple coexisting conditions and frailty. 6,49 The patient population that benefits most from referral to specialist-level palliative care and the appropriate timing of such referral are still being defined by empirical research, yet consensus recommendations support referral at the time of diagnosis for patients with advanced cancer, neurologic disease, or organ damage; those with multiple coexisting conditions, frailty, or advanced cognitive impairment; those with a high symptom or iatrogenic-treatment burden (e.g., those who have received a bone marrow transplant for acute leukemia); and those who have onerous family or caregiver needs regardless of prognosis. 2,36 …”

Identifying patients with chronic conditions in need of palliative care in the general population: development of the NECPAL tool and preliminary prevalence rates in Catalonia

“…Twenty years ago, WHO, in collaboration with the Catalan Department of Health, began a WHO Demonstration Project (WHO DP) in PC, and achieved high coverage in Catalan health districts 20. One of the aspects for improvement that was identified consisted of extending early PC provision for non-cancer patients into conventional services in all settings of the HCS.…”