Economics / service delivery Flashcards
What are the WHO main areas for improved palliative care delivery?
- improved drug access
- education
- policy
- quality
- research
List social barriers to access
- not currently defined as human right
- global inequities
- Economic barriers
- many do not have access to basic health care
- aging population, rising costs
- drug availability
- access to opioids limited
- cost, stigma
- Ethnicity
- less access for ethnic minorities
- homelessness
- lack of advacned care planning
- poor primary care
- Incarceration
List professional barriers to access
- Attitudes
- Lack of Knowledge
CSPCP priority disease groups needing better access to PC
- Advanced cancer
- end stage organ failure
- neurodegenerative disease
Pyramid Model of PC needs
- BASE - Community supports
- Primary Palliative Care
- Specialist Palliative Care
Describe three roles of a specialist palliative care service
- provides direct care to complex patients
- provides education and consultative support to generalists
- undertakes research / QI
Definition of a palliative care unit
- specialized unit that cares for complex patients and families
- standalone or in hospital
- symptom management
- provide support and care to allow discharge or transfer to another setting
Define Palliative Care Hospital Consult Team
- provide specialist level pall care consultative advice to other staff, patients, families in hospital
- formal and informal educational roles
- Work closely with other services
- core aim is symptom management
Define palliative care home care
- specialist pall care in the home settings
- advice to FP, nurses, PT, OT others
- advise, sometimes assume care
- doubles odds of patients being able to die at home
Palliative Care outpatient services : define
- may be offered jointly with onc, resp, neuro
- early integrated palliative care
Describe Palliative Care Day Care
- day hospice
- addition support/ respite care
- usually already enrolled in home care pall
Describe model of short term integrated palliative care
- given early integration and longer prognoses of patients, service can see in consultation, discharge back to referring service
- See again when decline/needs change
Define Cost Effectivness Studies
- Compares years of additional life gained and cost
- assigns cost per additional year of life saved
Disadvantages
- implies a limit to resources
- assumes all people share the same values
Eg:
- adjuvant chemo adds 5 months of additional life, at a cost of $15, 000 per year.
Define Cost Minimization Studies
- decisions and treatment based on clinical outcomes and cost
- 2 strategies are equally effective, the lower cost one is chosen to minimize costs
Disadvantages
- requires study of direct comparison of strategies / treatments, etc
- emphasizes immediate cost, not long term costs
Example:
- methadone equal to SR morphine. Methadone cheaper, therefore should be selected.
- survival is equal between palliative care and regular care, care is at least as good. Cost of PC lower.
Describe types of cost studies
- Cost Alone.
- ignores clinical outcomes
- rarely used. - Clinical outcomes alone
- ignores cost. Treatment A is superior. - Cost and clinical outcomes together
- Cost minimization
- Cost effectiveness
- Cost utility
- Cost benefit
Define Cost utility Analyses Studies
- QOL is utility ratio
- 0 = death, 1 = full health
- converts cost effectiveness into cost per quality adjusted life year
Disadvantges
- how and who should assing utility ratio value
- difficult to use in PC
- PC interventions dont usually change QOl values
Eg:
- intervention that costs 100K per year of life gained converts to 50K per QALY
Describe Cost Benefit analysis
- Compares 2 interventions
- assigns $ value to added clinical benefit based on economic productivity of patient
Disadvantages
- not very relevant in medicine, $ value to life
- most pall interventions do not allow patient to make income
Eg:
- Treatment costs $50K to prolng life by 1 year. Acceptable cost if offset by patient having 50K of economic worth that year.
Describe Cost Avoidance Analysis
- Measures costs saved by NOT doing intervention
- Commonly used a economic argument for pall care
Disadvantages
- needs patient level cost accounting
Eg:
- Moving from ICU bed to hospice bed saves $2500 per day.
What is the impact of hospice / PC on cost of care?
- hospice care saves $
- more money the longer hospice is used
- improved clinical care
What is the difference between LTC and Palliative care / hospice?
Long term care:
- developed separately from PC
- many are private businesses for profit
- patient ratios, regulated caregivers, inappropriate transfers to acute care, living conditions can be issues
- Physicians : visiting GP vs employed by LTC.
List 3 interventions to improve pall care in LTC setting?
- Communication
- consultation
- screening
- case conferences
- care planning
- Palliative Care leadership
- education for staff
- Targeted symptom control strategies
- screening
- protocols
Describe differences between Patient-centred care and Person centred care
Patient Centred Care
- episodic care
- centred around disease management
Person Centred Care
- focused on interrelatioships over time
- diseases are interrelated
- concerned with the evolution of the experience of health, not just the disease itself
WHO Chronic Care Model
Positive Policy Environment to make policy re: PC in LTC
Community to enhance PC in LTC
Health Care organization
