Journal of pain and symptom management
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Mongolia has established the foundation measures for a national palliative care program. Generic cost-effective opioids have been made available. Prescription regulations have been changed to allow opioid use according to good medical practice. Education on palliative care has been incorporated into the undergraduate curricula of doctors, nurses, and social workers, and the training of specialists in palliative care has been initiated concurrent with established standards for palliative care.
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J Pain Symptom Manage · May 2007
Review Historical ArticlePalliative care in Norway: a national public health model.
Palliative care (PC) in Norway has evolved in close cooperation between the health authorities and health care professionals. A number of official reports and national plans have promoted a stepwise development of PC services on all levels of the public health care system: tertiary care, with palliative medicine units in university hospitals coupled with research groups and regional Units of Service Development; secondary care, with hospital-based consult teams, inpatient units, and outpatient clinics; and primary care, with home care and designated PC units in nursing homes. The regional Units of Service Development are specifically assigned to research, education, and audit, as well as to development and coordination of services. ⋯ The Norwegian strategy for PC has resulted in rapidly increasing quantity and quality of services, but several challenges are still pending. Further improvement of the financial reimbursement system is needed, in particular concerning the funding for PC units in nursing homes. There are also challenges related to expertise and training, including establishing a program for palliative nursing and getting palliative medicine recognized as a medical specialty.
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The pain and palliative care fields are encouraged to learn about government drug control policy and to engage with their governments to examine these policies and their implementation in order to address impediments to patient access to pain management. Although pain management is a necessary part of palliative care, it is often impossible because strict national and state regulations block access to opioid analgesics. It is important for us to know that in adhering to international drug treaties, governments often concentrate on drug control to the exclusion of their obligation to ensure opioid availability for medical and scientific purposes. ⋯ The Pain & Policy Studies Group (PPSG) has developed methods and resources to assist governments and pain and palliative care groups to examine national policies and make regulatory changes. Romania, India, and Italy are examples. The PPSG is developing several new resources, including a training program for Fellows from low- and middle-income countries, enhanced support of collaborators working on opioid availability, an internet course in international pain policy, an improved website with policy resources and country profiles, and new approaches to the study of opioid consumption indicators.
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J Pain Symptom Manage · May 2007
ReviewKerala, India: a regional community-based palliative care model.
Kerala, in India, has shown enormous progress in the area of palliative care (PC). Most of it is due to the network of community initiatives in PC in north Kerala. This network, called "Neighborhood Network in Palliative Care," has more than 60 units covering a population of more than 12 million, and is probably the largest community-owned PC network in the world. The evolution and functioning of this network and the lessons learned are discussed.
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J Pain Symptom Manage · May 2007
Ensuring palliative medicine availability: the development of the IAHPC list of essential medicines for palliative care.
In response to a request from the World Health Organization (WHO), the International Association for Hospice and Palliative Care (IAHPC) developed a List of Essential Medicines for Palliative Care based on the consensus of palliative care workers from around the world. IAHPC designed a process of five steps, which included developing a set of ethical guidelines; identifying the most common symptoms in palliative care; identifying a list of medications to treat those symptoms; carrying out a survey using a modified Delphi process with participants from developed and developing countries; and convening a meeting of representatives from regional, international, and scientific organizations to develop the final list. Twenty-one symptoms were identified as the most common in palliative care, and an initial list of 120 medications resulted from the initial survey. ⋯ The IAHPC List of Essential Medicines for Palliative Care includes 33 medications, of which 14 are already included in the WHO Model List. The participants agreed that there is too little evidence to recommend medications for five of the symptoms and suggested that further research be carried out to solve this need. The IAHPC and all the organizations involved in this process welcome suggestions on ways to continue to improve the List of Essential Medicines for Palliative Care and to improve access to medications for patients in need.