International Palliative Care Network Lecture Series 2013 © Palliative Care Network International...

International Palliative Care Network

Lecture Series 2013

© Palliative Care NetworkInternational Palliative Care Network

Lecture Series 2013

Models of Care and Strategies to Provide Early Palliative Care

Delivery


Lecture Series 2013

Development of Palliative Care in Lebanon

Presenters:Dr. Hibah Osman

Ms. Loubna Batlouni


Lecture Series 2013

Balsam- Lebanese Center for Palliative CareBeirut, Lebanon


Lecture Series 2013

Hibah OsmanMedical DirectorBlasam- Lebanese Center for Palliative Care [email protected]


Lecture Series 2013

About the Presenter

Hibah Osman is a family physician and a palliative care specialist. She is founder of Balsam-Lebanese Center for Palliative Care and serves as its Medical Director. She recently received the Hospice and Palliative Medicine Certificate from the American Board of Family Medicine. She is in private practice and leads the palliative care team at the American University of Beirut Medical Center.


Lecture Series 2013

Loubna BatlouniOutreach CoordinatorBlasam- Lebanese Center for Palliative Care [email protected]


Lecture Series 2013

About the Presenter

Loubna Baltouni is the Outreach Coordinator at Balsam- Lebanese Center for Palliative Care. She is a public health professional with an interest in health promoting palliative care. She is responsible of awareness raising, advocacy, and capacity building activities at Balsam.


Lecture Series 2013

Conflict of Interest or Funding Source

• None


Lecture Series 2013

Outline• Palliative Care Milestones in Lebanon• Evolution of Models of Care• Palliative care delivery in Lebanon:

Challenges Facilitators

• Introducing Balsam The team The services Some figures

• Provision of Home-based Palliative Care- Balsam’s experience: Challenges at the healthcare provider level Facilitators at the healthcare provider level Challenges at the caregiver level Facilitators at the caregiver level

• Future of Palliative Care in Lebanon Recognition of palliative care as a specialty Advocacy activities of the National Committee

• Acknowledgement


Lecture Series 2013

Lebanon

• Area: 10452 km2

• Population: 4.5 million

• Health system:Highly PrivatizedNational Social Security FundMinistry of Public HealthOut of pocket expenditure


Lecture Series 2013

Palliative Care Milestones in Lebanon

1995: • Pain relief and Palliative Care identified as a priority during the World

Health Organization National Cancer Control Workshop• Morphine quota: 0.5Kg• Patients registered to receive opioids: 951999: • A full day symposium on Palliative Care and Ethics organized by the

Lebanese Cancer Society: Recommendations submitted to the World Health Organization Action plan submitted to the Ministry of Public Health


Lecture Series 2013

Palliative Care Milestones in Lebanon2000: • Two-day workshop organized by the Lebanese Cancer Society to discuss

the principles and barriers Need to introduce pain relief and palliative care in undergraduate medical curricula

identified

2001: • Nine fellows attended the “Education of Physicians on End-of-life Care”

course in the United States and one week of bedside training • Morphine quota: 4.5Kg• Patients registered to receive opioids: 600• Pain Relief and Palliative Care Group launched by the Lebanese Cancer

Society


Lecture Series 2013

Palliative Care Milestones in Lebanon2004: Legislative changes:• Physicians have the right to stop treatment if it is deemed “futile” by two

physicians• ‘Do Not Resuscitate’ orders can be legally written in a patient’s chart• Morphine supply can be provided for a 4 week period (previously 2

weeks)2009:• Opioids can be prescribed to cancer and non-cancer patients2010: Non Governmental Organizations that offer home-based palliative care are

established: The Lebanese Center for Palliative Care – Balsam The Home Hospice Association of Lebanon – Sanad


Lecture Series 2013


2011: • The Lebanese National Committee for Pain Relief and Palliative Care was

established Standards for pain relief and palliative care Strategies to engage professionals in the care process Models for service delivery Mechanisms to empower the patient and the family

2012:• A conference was held to share the work of the National Committee’s

subcommittees Education Practice Research Policy


Lecture Series 2013


2013:• An issue in the Lebanese Medical Journal will be dedicated to Palliative

Care and will report on the recommendations of the National Committee for Pain and Palliative Care

• Palliative medicine recognized by the Ministry of Public Health as a medical specialty

• First hospital based palliative care service established in Lebanon at the American University of Beirut Medical Center


Lecture Series 2013

Evolution of models of care

• Palliative care was not available in any setting in Lebanon

• Non-governmental Organizations that offer home-based palliative care were established (2010)

• The American University of Beirut Medical Center is building a hospital-based palliative care team (2013)


Lecture Series 2013

Palliative care delivery in LebanonChallenges:• Palliative care services not reimbursable by government nor by insurance

companies Organizations offer home based palliative care at no cost and are donor funded Fear of covering home-based palliative care because they cannot be easily monitored

• Laws do not facilitate advanced healthcare planning or goal setting, advanced directives are not legally binding

• Difficulties related to opioids availability and prescription Opioids can only be prescribed by oncologists and pain specialists Formulations of opioids available in the market are extremely limited Number of pharmacies that dispense opioids is limited (~30 pharmacies) Patients go through a complicated process to obtain opioids (multiple signatures

needed)• Lack of training among health professionals• Very few palliative care specialists in Lebanon


Lecture Series 2013

Palliative care delivery in Lebanon

Facilitators:• Advocacy activities of the National Committee for Pain Relief and Palliative

Care• Support and responsiveness of the Lebanese Ministry of Public Health


Lecture Series 2013

Introducing the “Lebanese Center for Palliative Care- Balsam”


Lecture Series 2013

The Lebanese Center for Palliative Care – Balsam is a non-governmentalorganization that works to relieve patient suffering and improve quality of life.Balsam provides holistic support to patients dealing with life-threateningillness by providing medical services as well as psychological, social, practical,and spiritual support within the family and home environment.


Lecture Series 2013

Balsam• Multidisciplinary Team:

PhysicianClinical psychologistClinical pharmacistNursesSocial worker

• Home-based services24 hours a day 7 days a weekAt no cost


Lecture Series 2013

Information about Balsam patients from September 2010 till December 2012

• 68 patients admitted (10 partial support, 58 full support)• 88% had a cancer diagnosis• 53 % of patients are females• 88% are Lebanese• 65 is the patient average age• age range is 20 to 90 years old.


Lecture Series 2013

Information about Balsam patients from September 2010 till December 2012


Lecture Series 2013

Patients admitted by month of referral

Number of patient-days in 2011

890

Number of patient-days in 2012

2490

Patient-days per year

•Monthly increase in admission rate•Yearly Increase in patient-days•Demand goes up as public awareness about the importance of palliative care increases•Obvious need for palliative care in Lebanon but very few providers offer the service

Provision of home based palliative care services

Challenges at the healthcare provider level:• Concerns about losing their patients• Concerns about losing income• Not convinced that the palliative care team could offer

services they could not offer themselves• Limited understanding of palliative care


Lecture Series 2013


Facilitators at the healthcare provider level:• Regular communication with treating physicians• Consistently involving treating physicians in major decisions• Restricting service to home-based care• Exposure to effective symptom management techniques

increased trust in the palliative care approach• Having nurses from the hospital working with Balsam helped

remind hospital providers about the availability of palliative services


Lecture Series 2013


Challenges at the caregiver level:• Equate opting for palliative care to “giving up”• Unclear about what the palliative care team could offer them• Concerned about loosing their relationship with their treating

physician


Lecture Series 2013


Facilitators at the caregiver level:• Provision of equipment or practical support was the easiest

way to gain entry. Trust was then built gradually.• Maintaining regular communication with their treating

physician reassured patients


Lecture Series 2013

Future of Palliative Care in LebanonThe recognition of palliative care as a medical specialty will

open the door to:• Hospital based palliative care services in medical centers• Community based palliative care services in primary health

care centers• Education programs and training opportunities about

palliative care and pain management for healthcare providers• Coverage of palliative care services by the government

followed by private insurance companies• Palliative care physicians will be allowed to prescribe opioids


Lecture Series 2013

Future of Palliative Care in Lebanon

The work of the National Committee for Pain and Palliative Care will open the door to:

• Amendments of laws and policies restricting palliative care practice and pain management

• The development of a national strategy


Lecture Series 2013

Acknowledgements

• The Lebanese Ministry of Public HealthMinister Ali Hassan KhalilDirector General Dr. Walid AmmarMembers of the National Committee for Pain

Relief and Palliative Care

• Balsam donors and supportersIndividualsOrganizations


Lecture Series 2013

International Palliative Care Network Lecture Series 2013 © Palliative Care Network International...

Documents

Transcript of International Palliative Care Network Lecture Series 2013 © Palliative Care Network International...