Economics / service delivery

Question 1

What are the WHO main areas for improved palliative care delivery?

Answer 1

• improved drug access
• education
• policy
• quality
• research

Question 2

List social barriers to access

Answer 2

• 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

Question 3

List professional barriers to access

Answer 3

• Attitudes
• Lack of Knowledge

Question 4

CSPCP priority disease groups needing better access to PC

Answer 4

• Advanced cancer
• end stage organ failure
• neurodegenerative disease

Question 5

Pyramid Model of PC needs

Answer 5

• BASE - Community supports
• Primary Palliative Care
• Specialist Palliative Care

Question 6

Describe three roles of a specialist palliative care service

Answer 6

• provides direct care to complex patients
• provides education and consultative support to generalists
• undertakes research / QI

Question 7

Definition of a palliative care unit

Answer 7

• 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

Question 8

Define Palliative Care Hospital Consult Team

Answer 8

• 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

Question 9

Define palliative care home care

Answer 9

• 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

Question 10

Palliative Care outpatient services : define

Answer 10

• may be offered jointly with onc, resp, neuro
• early integrated palliative care

Question 11

Describe Palliative Care Day Care

Answer 11

• day hospice
• addition support/ respite care
• usually already enrolled in home care pall

Question 12

Describe model of short term integrated palliative care

Answer 12

• given early integration and longer prognoses of patients, service can see in consultation, discharge back to referring service
• See again when decline/needs change

Question 13

Define Cost Effectivness Studies

Answer 13

• 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.

Question 14

Define Cost Minimization Studies

Answer 14

• 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.

Question 15

Describe types of cost studies

Answer 15

1. Cost Alone.
   - ignores clinical outcomes
   - rarely used.
2. Clinical outcomes alone
   - ignores cost. Treatment A is superior.
3. Cost and clinical outcomes together
   - Cost minimization
   - Cost effectiveness
   - Cost utility
   - Cost benefit

Question 16

Define Cost utility Analyses Studies

Answer 16

• 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

Question 17

Describe Cost Benefit analysis

Answer 17

• 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.

Question 18

Describe Cost Avoidance Analysis

Answer 18

• 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.

Question 19

What is the impact of hospice / PC on cost of care?

Answer 19

• hospice care saves $
• more money the longer hospice is used
• improved clinical care

Question 20

What is the difference between LTC and Palliative care / hospice?

Answer 20

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.

Question 21

List 3 interventions to improve pall care in LTC setting?

Answer 21

• Communication
  
  • consultation
  • screening
  • case conferences
  • care planning
• Palliative Care leadership
  
  • education for staff
• Targeted symptom control strategies
  
  • screening
  • protocols

Question 22

Describe differences between Patient-centred care and Person centred care

Answer 22

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

Question 23

WHO Chronic Care Model

Answer 23

Positive Policy Environment to make policy re: PC in LTC

Community to enhance PC in LTC

Health Care organization