What Is Palliative Today May Be Curable In The Future

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What Is Palliative Today May Be Curable In The Future
What Is Palliative Today May Be Curable In The Future

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Video: What's New in Best Practices? A Palliative Approach to Care in the Last 12 Months of Life BPG (2021) 2023, January
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What is palliative today may be curable in the future

The State Duma adopted in the third, final reading the law on palliative care, designed to settle the problem that has caused such a heated discussion in society in recent years, and promises to keep its implementation under control. The professional community welcomes the changes, although they admit that so far they do not solve all problems.

"What is palliative today may be curable in the future."
"What is palliative today may be curable in the future."

Photo: kremlin.ru /

The State Duma adopted in the third, final reading the law on palliative care, designed to settle the problem that has caused such a heated discussion in society in recent years, and promises to keep its implementation under control. The professional community welcomes the changes, although they admit that so far they do not solve all problems.

There are a huge number of seriously ill patients in Russia who need constant supportive therapy. As for people who have come to the end of their lives, then every second person needs palliative care. But not everyone gets it: most patients in the terminal stage are completely abandoned, only relatives or employees of social institutions try to solve their problems, where those who do not have loved ones go. Of course, this cannot be considered the norm: in the civilized world, doctors try to help maintain the quality of life even for doomed people.

The new law clarifies the concept of "palliative care" and defines the procedure for its provision on an outpatient basis and at home, as well as the procedure for social services for terminally ill people. The document regulates the provision of narcotic and psychotropic painkillers, and also establishes the right of terminally ill patients to receive medicines free of charge not only in inpatient conditions, as it was before, but also in a day hospital at the place of residence.

In addition, after the entry into force of the document, patients with serious illnesses will be able to claim free provision of medical products at home, "designed to maintain the functions of organs and systems of the human body." The complex of mandatory measures will also include psychological support for patients and their relatives. The procedure for the provision of assistance will be established by the Ministry of Health in its bylaws; when providing assistance, hospitals will be able to interact with social service organizations, public associations and NGOs.

Speaking at the parliamentary hearings "Legislative provision of palliative care in the Russian Federation," Chairman of the State Duma Health Protection Committee Dmitry Morozov drew the attention of their participants to the fact that palliative medical care is required for patients with a variety of diseases, therefore the forms and conditions for the provision of such care should also be different … “A child who requires long-term respiratory support is one clinical situation, a patient with multiple metastases who needs to be anesthetized - another, an elderly person who is fading away from CMB - the third,” Morozov explained. “At the same time, one must be very careful in the definitions, because what is palliative today may become curable in the future.This area is very heterogeneous, and of course, we need a clear state model with understandable funding for each of these areas."

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Such regional models for organizing the provision of palliative medical care, which, adjusted for geographic, demographic and economic indicators, could be taken as a basis in each constituent entity of the Russian Federation, were developed and proposed by a group of experts led by the Chairman of the Board of the Russian Association of Palliative Medicine, Head of the Department of Palliative Medicine, Moscow State University of Medicine and Dentistry. … A.I. Evdokimov Professor Georgy Novikov. Models include the possibility of outpatient care in palliative care rooms and at home with mobile visiting teams, care in a day hospital and a hospital. Inpatient care is provided in palliative care centers / hospitals, palliative care units,hospices (medical and social care with the use of opioid analgesics) or in the nursing department (medical and social care without the use of opioids).

According to the Association's experts, from 37.4 to 89% of all dying patients need palliative care. However, today in our country there are only 12 thousand inpatient beds, on which palliative patients are provided with the necessary complex of medical interventions, and 16 thousand beds for patients in need of medical and social assistance (at home / nursing departments, hospices). And this, of course, is very little.

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According to Professor Novikov, in order to provide high-quality palliative care, it is necessary, first of all, to determine its real need, to continue the development of palliative care in multidisciplinary hospitals and oncologic dispensaries, and to open a hospice in each region to help cancer patients in the terminal stage of the disease. In addition, palliative care centers (either independent or on a functional basis based on medical organizations, for example, a multidisciplinary hospital or a hospital for war veterans) should be created at the level of federal districts, territories, republics and regions.

According to the results of an epidemiological study conducted by the Moscow State Medical University. A.I. Evdokimov, on the instructions of the Ministry of Health of Russia, at least 20% of patients need the use of instrumental methods of palliative medical care, - said the expert. - And this assistance could be financed from the funds of the MHI. This would solve many problems in the provision of palliative care using instrumental methods of treatment (recanalization of hollow organs, puncture of cavities and vessels, stenting, various blockages, implantable pumps and dispensers)."

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The new law has finally given the green light to day hospitals, which can be an outlet for many families of incurable patients, especially when it comes to sick children. However, while in the Procedures for the provision of palliative care, there are still no hospitals / centers for palliative care, de facto existing in a number of regions, the expert notes. In addition, at present, the palliative care unit is included in only two Procedures for the provision of medical care - oncology and Geriatrics. “It is quite obvious that the provisions on such assistance should be included in the Procedures for the provision of medical care in other fields: cardiology, pulmonology, rheumatology, neurology and endocrinology, etc.,” says Georgy Novikov. -And physicians of medical specialties must master the modern methodology of chronic pain therapy, symptom control and psychological support for patients and their loved ones."

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