Identifying needs and improving palliative care of chronically ill patients:  a community-oriented, population-based, public-health approach.
OBJECTIVE
We describe conceptual innovations in palliative care epidemiology and the methods to identify patients in need of palliative care, in all settings.In middle-high-income countries, more than 75% of the population will die from chronic progressive diseases. Around 1.2-1.4% of such populations suffer from chronic advanced conditions, with limited life expectancy. Clinical status deteriorates progressively with frequent crises of needs, high social impact, and high use of costly healthcare resources.


RESULTS
The innovative concept of patients with advanced chronic diseases and limited life prognosis has been addressed recently, and several methods to identify them have been developed.


CONCLUSIONS
The challenges are to promote early and shared interventions, extended to all patients in need, in all settings of the social care and healthcare systems; to design and develop Palliative Care Programmes with a Public Health perspective. The first action is to identify, using the appropriate tools early in the clinical evolution of the disease, all patients in need of palliative care in all settings of care, especially in primary care services, nursing homes, and healthcare services responsible for care provision for these patients; to promote appropriate care in patients with advanced diseases with prognosis of poor survival.
The Qualy Observatory, WHO Collaborating Centre for Palliative Care Public Health Programs, Catalan Institute of Oncology, Barcelona, Spain. xgomez.whocc@iconcologia.net
Xavier
X
Gómez-Batiste
Marisa
M
Martínez-Muñoz
Carles
C
Blay
Jose
J
Espinosa
Joan C
JC
Contel
Albert
A
Ledesma
D002908:Chronic Disease; D003153:Community Health Services; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D010166:Palliative Care / Q000379:methods* / Q000592:standards; D011379:Prognosis; D011634:Public Health / Q000379:methods*; D011787:Quality of Health Care / Q000592:standards*; D018570:Risk Assessment / Q000379:methods