Palliative CareDevelopment in Chile

Laura Tupper SattFamily Medicine and Palliative Care

Unidad de Cuidados Paliativos

Complejo Asistencial Sótero del Río

Puente Alto, Santiago - Chile

11800 Kms

Population: 18 millionLife Expectancy: 79 years

Income: High

Health Spending: 1915 USD/habPhysicians: 1,03/1000 hab

Hospital beds: 2.1/1000 hab

17.2%

10 %

Elderly

populationTotal, % of population, 1984 –

2014

Source: Labour Force Statistics: Summary tables

Health Expenditure (% GDP)

Source: Chilean Central Bank

Total

Private

Public

Insurer FONASA Isapre

Population 74% 16.4%

Health Care Resources 40.5% 59.5%

Beds 28% 72%

Working Physicians 44% 56%

PrivatePublic

Chilean Health Care System

Palliative Care Development

Source: Ferández, Angela. Presentacion JJNN Programa Nacional de Cuidados Paliativos 2017

1990 (isolated services)

1999 (16 hospitals)

2003 (28 Outpatient Units)

Palliative Care Service Provision

“…an example of successful, high-quality, and integrated palliative care programs within Latinamerica”.

Palliative Care Needs

CancerCardiovasc.

diseasesDementia

Respiratorydiseases

Other Pediatric Infectious

nb patients 22546 15958 4544 2925 2002 1001 646

% 45% 32% 9% 6% 4% 2% 1%

0

5000

10000

15000

20000

25000

Palliative Care Needs by Diagnosis2% 1%

3%

12%

28%

54%

Palliative Care Needs by Age

< 15 yo

15 -29 yo

30 - 44 yo

45 -59 yo

60 - 74 yo

>75 yo

Nearly 100.000 patients, considering at least one caregiver, will need palliative care services

Source: De Allende-Salazar. MI. Estimation of palliative care needs in Chile, 2016 (unpublished data)

Palliative Care Service Provision

• Outpatient-based system• 129 Palliative Care Unit (PCU) = outpatient clinic unit• 60 PCU care for less than 100 patients/year, small teams. • 28.884 patients in 2017:

• 71% ≥ 65 years old

• 94% malignant disease (Gastric, Lung, Prostate and Breast cancer)

• Average during 10 months

• Partial Home Care provision• 32 % provided by primary care team only and 58% by PCU Team only in 2017

• Only 2 beds PC inpatient unit, consultant service.

• One private charity is the only hospice care provider (40 beds).

Palliative Care Service Provision

Facilitators Barriers

Good opioid Access and use in cancerpatients

o High Demand

Broad territorial distributiono Caring for less than a half of patients in need

of palliative care, only oncologic patients

Commited Palliative Care Teamso Opioids prescription limited to Palliative Care

Units

Professionals associations in initialstages

o Professionals lacking formal training

Right to palliative care recognized bylaw o Unequal resource distribution

A Case of SuccessUnidad de Cuidados Paliativos

Complejo Asistencial Sótero del Río

Puente Alto, Santiago de Chile

Description

• Our palliative care unit has been working since 2001; itstarted with 3 professionals, now we are more thansixteen.

• Our team is formed highly motivated by doctors, nurses, nurse assistants, social worker, psychologists, a receptionistand a driver.

• We care for about 1500 advanced cancer patients eachyear.

Our Services

• We are an outpatient-based service: 6000 consultations in the regular outpatient clinic and 4500 in a “fast-track” clinic, every year.

• Hospital: we are consultants in all wards (including all medical, surgical and orthopaedic services). Doctors and psychologists do 900 hospital consultations/year.

• Home visit: 1100 visits/year, usually as a team of two or three professionals: always a nurse and/or a nurse assistant, doctors and psychologist accordingto each family needs. We visit urban and rural patients.

Our Services

• Education for carers, individualised according to needs. Unpaidcaregivers are trained in the use of oral and subcutaneous medication, as well as basic nursing techniques.

• Volunteers visit socially deprived or highly stressed families at home and the hospital.

• Hospital clowns visit patients regularly in the waiting room in theoutpatient clinic.

Training and Research

• We participate in national and international conferences as assistants or speakers, where we present our researchwork.

• We receive healthcare professionals from other hospitalsor from primary care to support palliative care training.

Lessons Learned• Palliative Care services can be delivered

with a broad territorial coverage with a national program and legal protection.

• Need of extension to patients with non-malignant diseases.

• Access to opioids can be improved

• Formal training is essential

• Research development is feasible and should be encouraged

• Committed teams are irreplaceable

¡Muchas Gracias!Thank you very much!

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