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Palliative Care Regional Program in Extremadura, Spain

In February 2002, Extremadura had no public Palliative Care resources to fulfil the needs of the 2500 patients dying of cancer each year. The needs of Extremadura (a region with 1.1 million people, 41.602 km2, and eight hospitals), compelled  the new Extremaduran Health Service to design and implement an integrated Regional Palliative Care Program within the public health system.

In ten months, a project was developed which included an analysis of the local needs and the steps and resources needed to carry it out. In addition, four workgroups in quality improvement, assessment tools, treatments and training and research were formed. Eight palliative care support teams working in both acute hospitals and in the community were implemented in January 2003 to offer support to both hospitalized patients and palliative home care patients. 

Some of the initiatives carried out since the program's initiation include common assessment tools and clinical guidelines for all teams; official legislation to allow the use of hospital drugs at home and to require all primary care health centers to have minimal stock of opioids; educational brochures and general information documents; standardised basic Palliative Care Courses offered to health professionals throughout the region; standardised rotations and teaching sessions for residents and fellows; research protocols; organization and quality improvement studies and quality criteria index.

Since October 31 2003, more than 1,500 patients have been cared for by the Palliative Care Program, receiving a total of 8,000 visits and more than 10,000 treatment recommendations. One hundred per cent of the health centers have received clinical and teaching sessions on palliative care and pain and symptom management.

In only eleven months a well tailored Regional Palliative Care Program has been fully implemented, providing 100% geographical access to palliative care for all terminally ill patients in Extremadura. This shows that it is possible to implement a regional palliative care program integrated in the public health system. Three elements were needed: a clear technical knowledge of how to solve the problems, planning based on local needs, resources, and a consensus of professionals and authorities.

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