Development of Palliative Care in the Czech Republic
Zuzana Miškovská, MD, PhD, Society of General Practice, J. E. Purkyně Czech Medical Association
Aims: Since the number of palliative care beds has increased only slowly in the Czech Republic, essential general palliative care will continue to be provided mostly at general practitioners’ offices. Therefore it is suitable to identify initial positions, such as level, hidden reserves, and needs, in the primary care at the time of updating the Recommended Procedure and before the implementation thereof. Regular reassessment should provide valuable information about the effective implementation of the RP and the necessity of potential changes in the RP. For these reasons Dr. Miškovská included a special survey focused on palliative care in the agenda of the 27th Annual Conference of the Society of General Practice.
Methods: Questionnaire investigation. Question: a) We realize that the patient’s disease has reached the terminal phase. b) We enter this change into the patient’s records, c) We change the medication, d) We ensure home infusions, e) We talk openly with the patient about the impending death, f) We talk with the patient’s family about the impending death.Our patients mostly die: g) at home, h) in the hospital, i) we don’t know, nobody tells us.
Results: Only half of the practitioners change the medication, and one-third of the practitioners ensure infusions in a home setting. The practitioners talk mostly with the patient’s family about the impending death.When patients are dying at home, the strongest correlation was found between education and supportive discussions with the family about the impending death.
Conclusion: The negative facts revealed suggest the need for a systemic solution:
1/ Education in legal matters, 2/Education concerning changes in the chronic medications of terminally ill patients, 3/ Education concerning the management of acute conditions in terminally patients in a home setting.