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Eastern Europe
EAPC-East Newsletter
NR 17- December 2003
Reprinted with permission

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This last EAPC-East Newsletter for 2003 is longer than usual because we wanted to give you direct access to all the plans and participants from the meeting in Budapest October 2003 on changing palliative care policies. But we wanted to squeeze in some other information as well. Hope your mailboxes make it!

Council of Europe Recommendations for palliative care - for all of us
The final recommendations by the 45 countries were adopted by the Committee of Ministers with favorable comments on November 12, 2003. The official disclosure is not yet published but the semi-official file can be down loaded from the web site

The recommendations will be sent to each country, but only sample copies. The member state can buy more copies from the Council of Europe during the first 6 months - they are supposed to distribute them.

We - EAPC are now discussing how to do a joint activity in Europe to spread the knowledge about palliative care and about the recommendations. The plans include you all!  If you have ideas for how to disseminate into the communities, please let us know!

1st Conference of Bulgarian Association for Palliative Care,
Sofia, Bulgaria 5 - 7
February 2004
The accents of the conference are:
- gathering and exchange of experience,
- promotion of standards in palliative care
- initiation of changes in the healthcare policy for palliative care to be accessible 
- educational aspect of palliative care in colleges and universities will be discussed as well.

The foreign guests who will be present will share their experience in terms of organization, financing and methods of work. There will be simultaneous Bulgarian-English and English-Bulgarian translation

It is the first event of its kind in Bulgaria and we will be glad to welcome as many participants as possible from whole Bulgaria maximum being 60 participants.

The event is financed by Open Society Foundation and there is no fee to attend. For further information and application please contact Ms Iglika Gardeva,  [email protected]

ABC of Palliative Medicine from BMJ
Difficult pain problems by, J Sykes, R Johnsson and GW Hanks is the third article from BMJ´s clinical articles on palliative care that you can down load from the EAPC-east web site.

Action plans for palliative care in 12 different countries
Here are the written plans and the participants from the attending countries in the Budapest meeting on changing policy on palliative care, October 03

Hopefully this information will inspire you to ask for progress on the plans to the appropriate persons in your respective country. Good luck!

Bulgaria  - Goals and Action Plan

To develop palliative care standards
· Create a workgroup to prepare national standards with financial support from Dept of Health and Informational resource--one year deadline
Change Opioid Law
· Create a work group including MoH, National Insurance Institute, Health Group of Parlament with support from colleagues from EAPC--one year deadline
Include home palliative care in National Health Insurance
· Create working group with professional physicians organization that will present suggested package who should buy financing from health system--three year deadline

Alexandrov Stoyan, Director of Directorate Diagnostic and Curative activities, Ministry of Health, Sofia,  [email protected]
Kalinka Balabanova, Teacher Medical College, Plovdiv, [email protected]
Dimitar Dimitrov, Chairman Bulgarian Ass for Palliative Care, Plovdiv, [email protected]
Sashka Ruskova, National Health Insurance Fund, Chief of Dept of Hospital Care, Sofia, [email protected]

Czech Republic

. Improve the cultural-social background and the education of the society
. Cultivation of a dying process in long-term care facilities
. Effective client-focused financing

Improve the cultural-social background and the education of the society

  • Translation of the WHO and COE publications on PC and present them on the national level for politicians and decision makers (Launched with OSI and other international PC celebrities)
  • Try to improve the media made picture of the health reform as bringing not only restrictions of resources (financial) but as bringing an effective improvement of quality of care (using PC as a model of improving type of care of progressively ill people)
  • Coordination and unifying the experiences and points of views of NGOs and all other subjects aiming at improving the care of progressively ill people
  • Using well-known and/or important persons of public life to initiate a public discussion about all the questions related to death and dying in comparison with a current poor situation in this field

Cultivation of the dying process in long-term care facilities

1. Re-structuralisation of types of care for those who are cared in long-term care facilities
2. Identifying groups of patients according to their unmet needs
a) palliative
- terminal care pts. b) rehabilitable (convalescent) pts.
c) chronical basic nursing care pts. d) residential pts. (respite care)

3. Using minimal data sets and Comprehensive Geriatric Assessment
4. Interdisciplinary consensus within all the responsible participating subjects - Geriatric and
    Palliative Care Societies
5. Supporting home-based care and home-based palliative care as a comprehensive and complex care provided by multiprofessional teams to reduce the number of hospitalisations

6. Supporting hospital-based palliative care teams and/or clinics

Effective client-focused financing

Precise financing of PC according to defined needs of patient groups (categories)

  • Prognosis (estimated life expectancy) and counselling needs
  • Symptom severity - pain, passage + nutrition, dyspnoea, fear/anxiety/depression
  • Severity of skilled nursing
  • Severity of basic nursing (ADL)
  • Family support needs (bereavement)

Zdenek Bystricky, Physician District Hospital, Blansko [email protected]
ZdenekKalvach, Senior lecturer of geriatrics and internal medicine, Charles University, Prague, [email protected]
Antonin Pecenka, Head of Departmen of Health Care, General Health Insurance Company, [email protected]
Martina Spinkova, Director Home Palliative Care Service-Cesta Domu, Prague, [email protected],
Ludmila Vostrakova, Director, Social Health Care Department, Ministry of Health, [email protected]

Hungary Goals and Action Plan

To include the PC into the existing health care system

Minimum standards

  • Means to define clearly the meaning of PC
  • Providers of PC (numbers, education)
  • Minimum level of care in different organisational forms
It is the basis of the legal existence of PC in the health care system

Pilot project to integrate PC into public health

  • Elaboration of a two years model program for helping the integration
  • Ask for applications
Set up the financial backgrund (NHS) of PC

Goal: financing of 70% of PC costs

Action Plan

  • 31 October 2003 - elaboration of minimum standards
  • 31 March 2004 - quality insurance to modification of regulation
  • 30 April 2004 - ask for application
  • 1 July - Launch of model program

Ferenc Alfoldy, Senior Councellor of medical and nursing department of Ministry of  Health, Social and Family affairs, [email protected]
Csaba Dozsa, Deputy Director General for Health policy and Health Care, National Health Insurance  Fund, [email protected]
Ferenc Falus, President National Health Council, [email protected]
Arpad Gogl, President Monitoring Subcommittee, Health Care Committee Hungarian Parlament, [email protected]
Katalin Hegedus, member of board of directors of EAPC, professor of bioethics, Semmelweiss Medical University, Budapest, [email protected]
Eva Kereszty, Leader of medical and nursing department of Ministry of Health, [email protected]
Agnes Ruzsa, President of Hungarian Hospice-Palliative Association , Chief of the oncological department, Zalaegerszeg,  [email protected]

Lithuania - Goal

To integrate Palliative Care (PC) in the National Health Care System using the existing situation and resources

  • The preparation, confirmation of the legal basis
  • Analysis and reallocation of resources
  • Raising awareness and education

The preparation and confirmation of legislation basis

  • Evaluation of the existing legislation basis and suggestions for the changes, and confirmation
  • The preparation PC norms and standards and confirmation
  • The preparation of PC strategy and confirmation

Analysis and reallocation of resources

  • Evaluation of existing human, financial and institutional/technical and structural resources.
  • Preparation recommendations of the reallocation of the resources and presentation to the discussion for the Health Care Ministry.

Awareness and education

  • To prepare qualification standards for specialists in palliative care

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