The current situation of pall iative care in Thailand

Patama Gomutbutra MD.Assist Prof. of family medicine

Chiang Mai university pgomutbu@med.cmu.ac.th

Purpose

Process

Performance

WHAT:PERFORMANCE OF PALLIATIVE CARE IN THAILAND

2006

2012

Opioid consumption 3. 96 mg/capita compare with 693 mg/capita of USA

The current situation of palliative care service in Thailand.

THAPS’ survey 2012

Asso.prof. Temsak Phungrassami.Faculty of medicine. University of Songkla.

Rojanasak Thongkhamcharoen .Maesod hospital.

Narumol ArkkakulNational health security office (NHSO)

Health care unit in Thailand

• 1,002 public hospitals 316 registered private hospitals.

• Level of public hospitals - Primary care (community) hospital - Secondary care (general) hospital - Tirtiary care (regional) hospital - University hospital - Specialized center eg. Cancer center

Pri. H Sec.H Tir. H U. H Ca.C Private H.

Percentage of pall iat ive care service in each type of Health care unit

EAPC recommendation: standard and norms for hospice and palliative care 2009 http://www.eapcnet.eu/Themes/Organisation/EAPCStandardsNorms.aspx

Graded system of Palliative care service (European standard)

McCain Chiang Mai Nursing home ( so called hospice)

One GP (my husband)with 7 nurse: 30 beds

Pri. H Sec.H Tir. H U. H Ca.C Private H.

Percentage of Morphine availabil i ty in each type of Health care unit

Pri. H Sec.H Tir. H U. H Private H.Ca.C

Percentage of Physician got PC training in each type of Health care unit

“12” physicians ! have year long

palliative training

year(s)

month (s)

week (s)

day(s)

N/A

Percentage of Nurse got PC training in each type of Health care unit

Pri. H Sec.H Tir. H U. H Ca.C Private H.

year(s)

month (s)

week (s)

day(s)

N/A

Caveat about the results

• Response rate 57% (private hospital 19%)

• Each unit situation may be answered by who not know all information.

Dr. Temsak“ CMU has no pain clinic.

REALLY ! “

Thailand quality of death ???

15

HOW:PROCESS OF PALLIATIVE CARE IN CHIANGMAI UNIVERSITY

Patients contact to local health care unit themselves

Follow up by phone in some case

Training physician

• 4th year MD : Lecture principle• 6th year MD : Practice in

community and sent case report• FM resident

- ward consultation aka.shared care- Home visit (not home hospice

Case report from rural sent via Moodle e-learning

GAP of knowledge & practice

•Practice in community( From med students case reports)

•5% of in CA lung got opioid/BZD for dyspnea

•0% of COPD, CHF

•90% non-hypoxia pt. got home oxygen

Example : Management of advance illness dyspnea

WHY:PURPOSE OF DOING MORE“IMPACT” RESEARCH IN PALLIATIVE CARE

Impact = Support clear massage

• Image triangle “Benefit” “Right” of getting palliative

care

“Indicator” of good death

“Expectation” from optimal treatment

Summary situation of pall iat ive care in Thailand

• Our palliative care is being in the “lag” page

• Initiation/Production is not a big problem

• The problem is Communication/Distribution

Thank you for your attention

• Welcome for.. Question Suggestion

Collaboration

Thank you for

• Prof.Tai-Yuan Chiu and The National Taiwan university• Suandok palliative care team• Dr. Temsak, Dr.Sakol

Dr. Rojjanasak, Dr.Linchong, Dr.Tipaporn