title: Identification and characteristics of patients with palliative care needs in Brazilian primary care.
abstract: BACKGROUND
  The Brazilian healthcare system offers universal coverage but lacks information about how patients with PC needs are serviced by its primary care program, Estratégia Saúde da Família (ESF).
  
  
  METHODS
  Cross-sectional study in community settings. Patients in ESF program were screened using a Palliative Care Screening Tool (PCST). Included patients were assessed with Karnofsky Performance Scale (KPS), Edmonton Symptom Assessment System (ESAS) and Palliative Care Outcome Scale (POS).
  
  
  RESULTS
  Patients with PC needs are accessing the ESF program regardless of there being no specific PC support provided. From 238 patients identified, 73 (43 women, 30 men) were identified as having a need for PC, and the mean age was 77.18 (95 % Confidence Interval = ±2,78) years, with non-malignant neurologic conditions, such as dementia and cerebrovascular diseases, being the most common (53 % of all patients). Chronic conditions (2 or more years) were found in 70 % of these patients, with 71 % scoring 50 or less points in the KPS. Overall symptom intensity was low, with the exception of some cases with moderate and high score, and POS average score was 14.16 points (minimum = 4; maximum = 28). Most patients received medication and professional support through the primary care units, but limitations of services were identified, including lack of home visits and limited multi-professional approaches.
  
  
  CONCLUSIONS
  Patients with PC needs were identified in ESF program. Basic health care support is provided but there is a lack of attention to some specific needs. PC policies and professional training should be implemented to improve this area.
authors.affiliation: Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Brazil. fcim@msn.com.|, Av. Robert Koch, 60. Vila Operaria, 86038-350, Londrina, Parana State, Brazil. fcim@msn.com.
authors.forename: Fernando C I
authors.initials: FC
authors.lastname: Marcucci
authors.affiliation: Department of Internal Medicine, Universidade Estadual de Londrina, Londrina, Brazil.
authors.forename: Marcos A S
authors.initials: MA
authors.lastname: Cabrera
authors.affiliation: School of Medicine, Universidade Estadual de Londrina, Londrina, Brazil.
authors.forename: Anamaria Baquero
authors.initials: AB
authors.lastname: Perilla
authors.affiliation: School of Medicine, Universidade Estadual de Londrina, Londrina, Brazil.
authors.forename: Marilia Maroneze
authors.initials: MM
authors.lastname: Brun
authors.affiliation: School of Medicine, Universidade Estadual de Londrina, Londrina, Brazil.
authors.forename: Eder Marcos L
authors.initials: EM
authors.lastname: de Barros
authors.affiliation: School of Medicine, Universidade Estadual de Londrina, Londrina, Brazil.
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: Martins
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
authors.forename: John P
authors.initials: JP
authors.lastname: Rosenberg
authors.affiliation: School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
authors.forename: Patsy
authors.initials: P
authors.lastname: Yates
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology; D001938:Brazil; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009313:National Health Programs / Q000458:organization & administration / Q000706:statistics & numerical data; D020380:Needs Assessment; D010146:Pain / Q000453:epidemiology; D010166:Palliative Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D000070659:Patient Comfort / Q000458:organization & administration / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013997:Time Factors
keywords: Family health; Government Programs; Palliative care; Primary health care