Implementation of palliative care consult Service in Hungary – integration barriers and facilitators

Abstract

Background: The Palliative Care Consult Service (PCCS) programme was among the first initiations in Hungary to provide palliative care for patients admitted to hospital. The PCCS team provides palliative care for mainly cancer patients and their family members and manages the patient pathway after being discharged from the hospital. The service started in 2014 with 300-400 patient visits per year. The aim of this study is to give a comprehensive overview of the PCCS programme guided by a conceptual framework designed by SELFIE ("Sustainable intEgrated chronic care modeLs for multi-morbidity: delivery, FInancing, and performancE"), a Horizon2020 funded EU project and to identify the facilitators and barriers to its wider implementation. Methods: PCCS has been selected by the SELFIE consortium for in-depth evaluation as one of the Hungarian integrated care models for persons with multi-morbidity. The qualitative analysis of the PCCS programme was based on available documents of the care provider and interviews with different stakeholders related to the programme. Results: The integrated, multidisciplinary and patient-centred approach was well-received among the patients, family members and clinical departments, as verified by the increasing number of requests for consultations. As a result of the patient pathway management across providers (e.g. from inpatient care to homecare) a higher level of coordination could be achieved in the continuity of care for seriously-ill patients. The regulatory framework has only partially been established, policies to integrate care across organizations and sectors and adequate financial mechanism to support the enhancement and sustainability of the PCCS are still missing. Conclusions: The service integration of palliative care could be implemented successfully in an academic hospital in Hungary. However, the continuation and enhancement of the programme will require further evidence on the performance of the integrated model of palliative care and a more systematic approach particularly regarding the evaluation, financing and implementation process.

User-centred Design of a Clinical Decision Support System for Palliative Care: Insights from Healthcare Professionals

“…In those different contexts, physicians and nurses play different roles in the PC needs identification. For example, in the work by Zemplényi et al [45] the authors describe how the nurses are the first to detect the needs and then the cases are discussed with the physicians. This may be different in other settings, such as rural areas where physicians visit older patients.…”

Introducing palliative care into cancer treatment

“…The primary challenge in the implementation of PC in this particular patient population is clinical acceptance and how to properly adapt current care practices in these units to fit PC activities. This includes management of pain and other symptoms, providing psychosocial support, and eventual facilitation of appropriate transfer to hospice or discharge to home PC 15. By using an interdisciplinary team, including the oncologist, PC physician, clinical nurse, and other caregivers as necessary, a comprehensive treatment plan that is personalized to the individual patient can overcome this challenge 15,16…”

Early palliative care associated with lower costs for adults with advanced cancer: evidence from Hungary

“…Further care is organised based on this treatment plan. The consultation service also includes subsequent patient follow-ups (Zemplényi et al, 2020).…”

“…The access to palliative care services in Hungary is reportedly limited due to the insufficient funding. Although service integration of palliative care could already be implemented from EU funds in some hospitals in Hungary, palliative care consult services (PCCS) are not yet reimbursed by the National Health Insurance Fund (Zemplényi et al, 2020).…”