title: Palliative care development in Latin America: an analysis using macro indicators.
abstract: BACKGROUND
  Recently, the Latin American Association for Palliative Care developed 10 indicators to monitor the development of palliative care and enhance the development of regional and national strategies.
  
  
  OBJECTIVE
  To compare the status of palliative care development across Latin American nations using the Latin American Association for Palliative Care indicators and to classify the countries into three levels of palliative care development.
  
  
  METHODS
  A secondary analysis using the following indicators (number of indicators in each category): Policy (1), Education (3), Service Provision (3), and Opioids (3). A Latin American Association for Palliative Care Index was constructed adding the standard score (z-score) of each indicator.
  
  
  METHODS
  Nineteen Spanish and Portuguese-speaking countries of Latin America.
  
  
  RESULTS
  Indicators significantly associated with the number of palliative care services per million inhabitants included: the proportion of medical schools with palliative care at the undergraduate level (p = 0.003), the number of accredited physicians working in palliative care (p = 0.001), and opioids consumed per capita (p = 0.032). According to the Latin American Association for Palliative Care Index, Costa Rica registered the highest score (8.1). Three ranking groups were built to measure palliative care development; Costa Rica, Chile, Mexico, and Argentina ranked in the high group, while Bolivia, Honduras, Dominican Republic, and Guatemala ranked in the lowest group.
  
  
  CONCLUSIONS
  Most of the Latin American Association for Palliative Care indicators are useful for assessing national levels of palliative care development. These indicators may be applicable to other world regions. Additional studies are needed to evaluate the specificity of each indicator.
authors.affiliation: Department of Palliative Medicine, University Hospital RWTH Aachen, Aachen, Germany tpastrana@ukaachen.de.
authors.forename: Tania
authors.initials: T
authors.lastname: Pastrana
authors.affiliation: Graduate College of Social Work, University of Houston, Houston, TX, USA Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Isabel
authors.initials: I
authors.lastname: Torres-Vigil
authors.affiliation: International Association for Hospice and Palliative Care (IAHPC), Houston, TX, USA.
authors.forename: Liliana
authors.initials: L
authors.lastname: De Lima
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D003431:Cross-Cultural Comparison; D003906:Developing Countries; D004502:Education, Medical, Continuing / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D010166:Palliative Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*
chemical_list: D000701:Analgesics, Opioid
keywords: Latin America; Palliative care; development; indicators