Regional Reports – WHO, USA, Spain
& Europe
From the WHO
Thirty-fourth Expert Committee on Drug Dependence,
(28 to 31 March 2006 )
In its 34th meeting, the Expert Committee discussed several issues that are of outstanding interest for public health and for this reason I would like to recommend this report to you. Of particular interest are the paragraphs that deal with the issues of access to controlled medicines for legitimate medical use, including opioids for the treatment of severe pain.
For instance, in paragraph 6.4, impact of international control on medical availability of substances, the Committee points out that drug control can create barriers for legitimate medical use, including barriers inadvertently created by the application of national laws and regulations. In some countries stricter measures are applied than required by the Conventions. Therefore, the Committee recommends that the appropriate national authorities should carefully consider whether any such measure could be modified to improve access for patients in need.
With regard to the use of buprenorphine for the treatment of opioid dependence, the Committee confirmed in paragraph 2.2.1, that this treatment is very important for the efficacious and cost-effective prevention and treatment of HIV/AIDS. Therefore, this treatment is beneficial for both the health of opioid-dependent patients, and for reducing transmission of HIV/AIDS among the general population.
We should like to use this opportunity to express our thanks to the members of the Expert Committee on Drug Dependence for all the work they did before, during and after the meeting. We also wish to thank the National Institute on Drug Dependence, Peking University, Beijing, China, for its efforts to publish a version in Chinese and the Fundacion De Lima Bohmer, Cali, Colombia, for financing the Spanish version of this report.
I hope you will find this Expert Committee report both interesting and useful.
With kind regards,
Willem Scholten, PharmD., MPA
Technical officer
World Health Organization
Quality Assurance and Safety: Medicines
Department of Medicines Policy and Standards 20,
Avenue Appia
1211 Geneva 27
Switzerland
Tel +41 22 79 15540
Mobile +41 7 9449 5759
Fax +41 22 79 14761
e-mail: [email protected]
The report of the Thirty-fourth Expert Committee on Drug Dependence, (28 to 31 March 2006 ) is available on the WHO website:
http://www.who.int/medicines/areas/quality_safety/WHO_TRS_942.pdf
The present version is in English, but we expect French, Spanish, Russian and Chinese versions soon.
I want to draw your attention for our webpages on substance abuse and access to controlled medications which were renewed recently. They can be found on:
http://www.who.int/medicines/areas/quality_safety/sub_Int_control/en/
Here you can also find all former reports of the ECDD back to 1949.
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From the USA
Source: American Academy of Hospice and Palliative Medicine (AAHPM), American Board of Medical Specialties (ABMS), amednews.com
“Boards Sponsor Certification in Hospice and Palliative Medicine ABMS Boards Sponsor Certification in Hospice and Palliative Care Medicine
Starting in 2008, family physicians, internists and doctors in eight other specialties can be board certified in hospice and palliative medicine. Medical leaders reported that the subspecialty certificate would ensure that more doctors provide quality care to patients with serious and progressive illness. This is the first time 10 American Board of Medical Specialties (ABMS) member boards have collaborated to offer certification in one area, according to board leaders. Co-sponsoring the new certification are certifying boards in family medicine, internal medicine, emergency medicine, obstetrics and gynecology, pediatrics, physical medicine and rehabilitation, anesthesiology, psychiatry and neurology, radiology and surgery.
"Each of the co-sponsoring boards recognizes the growing importance of this area of medicine," said James C. Puffer, MD, president and CEO of the American Board of Family Medicine. Hospice and palliative medicine groups asked several boards to consider developing the subspecialty certification. The ABMS unanimously approved the certification in September 2006. The new certificate will be offered to physicians who hold specialty or subspecialty certification by one of the 10 sponsoring boards, the ABMS said.
Participating boards will develop core requirements and an exam for the certificate. Each board will announce when the certification will be available, Dr. Puffer said, and will publish criteria to sit for the board exam. The certificate will be renewable every 10 years, depending on completion of education, training and exam requirements. The first exam likely will be offered in 2008.”
“PRESS RELEASE FROM: HELP THE HOSPICES ( UK ), INTERNATIONAL OBSERVATORY ON END OF LIFE CARE AND NATIONAL HOSPICE AND PALLIATIVE CARE ORGANIZATION ( USA )
10th January 2007
HALF OF ALL COUNTRIES HAVE NO HOSPICE OR PALLIATIVE CARE, FINDS NEW REPORT
New research published by The International Observatory on End of Life Care (IOELC) at Lancaster University has found that around half of the world's 234 countries have no palliative care services available to their populations and one third have yet to take the first steps in planning to build service capacity. In those countries where hospice and palliative care services are present, provision is mostly localised, with only 15% of countries having achieved a measure of integration with mainstream healthcare service providers.
The report, entitled Mapping levels of palliative care development: a global view, also reveals a strong correlation between palliative care provision and levels of human development, as measured by the United Nations Human Development Index (HDI). Of the 35 countries where hospice-palliative care services are approaching mainstream integration, 29 have a high level of human development, while only one is described as having 'low development'. Of the 78 (33%) countries with no identified hospice-palliative care activity, only two have a high level of human development.
In the 80 countries with localised hospice and palliative care services there are many instances where services are mostly inaccessible to the whole population. In Pakistan, for example, there is only one service for a population of 158 million. This contrasts sharply with Gibraltar, where the service-to-population ratio is the lowest in the world at 1:14,000 (i.e. one service per 14,000 people).
Revd Dr Michael Wright, who led the project, commented, "Despite increasing international calls for high quality end of life care to be recognised as a human right, there is clearly a long way to go before it is within reach of most of the people in the world. It is particularly unfortunate that countries where there is the most need, particularly those heavily affected by the AIDS epidemic, are often those with little or no hospice and palliative care services.
"There are many barriers to service development; often palliative care is not regarded as a core healthcare service, which of course it is, and limited resources are not allocated to it. There can also be political or cultural opposition, for example to the use of morphine, and factors associated with a country's geography, population and infrastructure can also throw up big challenges."
The goals of palliative care are to improve the quality of a seriously ill person's life and to support that person and their family during and after treatment.
Four groups
The report was jointly commissioned by Help the Hospices in the UK and the National Hospice and Palliative Care Organization in the US . It builds on an IOELC study in Africa published in 2006 which put forward a four-part typology depicting levels of hospice and palliative care development.
The following four groups were identified:
1) no known hospice and palliative care activity
2) capacity-building activity but no service yet
3) localised provision of hospice and palliative care
4) hospice and palliative care provision approaching integration with the wider health system
The new report finds that more work is now needed to further develop the typology in order to assist those engaged in policy and service development, to construct a broader evidence-base for informed decision-making and to develop a cohesive system for service identification. ”
The full report is available online at
http://www.nhpco.org/files/public/palliativecare/World_map_report_final-0107.pdf
National Hospice and Palliative Care Organization (NHPCO) Hospice Quality Measures Included in New Reports on U.S. Healthcare
The Health and Human Services (HHS) Reports Find Missed Opportunities in Healthcare for Americans
Read the press release of January 16, 2007:
http://www.nhpco.org/i4a/pages/Index.cfm?pageID=5102
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From Spain
The SECPAL wins the Spanish National Award on Excellence of Scientific Societies
The SECPAL (Spanish Society for Palliative Care) has been awarded the National Award on Excellence of Scientific Societies.
The two main reasons for the prize are SECPAL’s commitment to the quality of care of patients and families and the promotion of palliative care in the National Health System.
SECPAL has developed many documents and papers on standards, quality criteria, and indicators. It has also strongly promoted the political and social awareness that access to palliative care is a right of every patient and family who needs it. There is a consolidated SECPAL policy on the standards of service that was recently implemented with regional consensus.
As a result of this, and following the path of Catalonia, Canary islands, and Extremadura, there is a new National Plan that is to be approved in January. Most regions will have Regional Palliative Care Plans in 2007 that will have a public health approach that will contribute to enormous coverage in the next few years.
Xavier Gómez-Batiste, MD, PhD
President SECPAL
Institut Català d'Oncologia
Barcelona, Spain
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From Europe
Dear Colleagues and Friends
A new EAPC task force was established in Spring 2006 with the aim of surveying national association organizational development and their needs. The group aims to understand the needs of a broad spectrum of national associations across Europe.
Aims and Objectives
The task force aims to survey national association organizational development and find needs according to stages of development – be it beginnings, growth, maturity and decline. Based on the outcomes of this survey a training programme will be developed, including a session at the EAPC Hungary 2007 Conference. The steering group recognizes the need for open communication with all national associations. It notes there are a number of different definitions of national associations and sometimes more than one national association per country.
Members
This taskforce is a collaboration between EAPC and Help the Hospices. The steering group aims to include as wide a spectrum of national associations across Europe as possible, representing the mix of existing associations, large and small.
The steering group consists of the following:
Chair: David Praill, CEO, Help the Hospices
Members:
Ole Bang, Denmark
Amelia Giordano, EAPC
Philip Larkin, EAPC and Ireland
Natasa Millicevic, Serbia
Dr Daniela Mosiou, Romania
Eugene Murray, Ireland
Nick Pahl, Help the Hospices
Andre Rhebergen, EAPC and CEO Agora, Holland
Observers:
Amanda Bingley, International Observatory on End of life care;
John Bowis, UK MEP (when appropriate)
The Steering group invites the representatives of the European national association to get in contact and act as key reference points for the group.
Note:
The EAPC Task Force on Development of PC in Europe uses the WHO definition of the European region - which has been considered to determine the 52 countries to be included in this study.
http://www.euro.who.int/AboutWHO/About/MH
Please complete the survey
If you are part of a national association, please complete the short questionnaire about your national association work at www.wwpca.net. Versions are available in English, French, Italian, Spanish and Russian. The survey will be used to provide information for planning of support to national associations and be available to all interested parties and groups. We hope you can complete the questionnaire by the end of November 2006.
Other Activity
If you would like to join a new email discussion group on this topic please e-mail [email protected]. Please send the e mail with the word “subscribe” in subject to this e mail.
Please also visit the website for national associations across the world at www.wwpca.net.
Contact
If you have any questions regarding the questionnaire or want to discuss the task force please contact Nick Pahl at [email protected]
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