Fundación Valle del Lili, Department of Pediatric Palliative Care , Cra 98 # 18 -49, Cali, 760032, Colombia.
Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, 760032, Colombia.
BMC Palliat Care. 2020 Nov 6;19(1):170. doi: 10.1186/s12904-020-00674-2.
The disparities in access to pediatric palliative care and pain management in Latin America remains an unaddressed global health issue. Efforts to improve the development of Palliative Care (PC) provision have traditionally targeted services for adults, leaving the pediatric population unaddressed. Examples of such services are scarce and should be portrayed in scientific literature to inform decision-makers and service providers on models of care available to tackle the burden of Pediatric Palliative Care (PPC) in Low-and middle-income countries (LMIC). The purpose of this study is to describe the implementation of a pediatric palliative care program, "Taking Care of You" (TCY), in a tertiary care, university hospital in Cali, Colombia.
A program's database was built with children between 0 to 18 years old and their families, from year 2017 to 2019. Descriptive analysis was carried out to evaluate the impact of the program and service delivery. A theory-based method was directed to describe the PPC program, according to the implementation of self-designed taxonomy, mapping theoretical levels and domains. Clinical outcomes in patients were included in the analysis.
Since 2017 the program has provided PPC services to 1.965 children. Most of them had an oncologic diagnosis and were referred from hospitalization services (53%). The number of ambulatory patients increased by 80% every trimester between 2017 and 2018. A 50% increase was reported in hospitalization, emergency, and intensive care units during the same time period.
The program addressed a gap in the provision of PPC to children in Cali. It shows effective strategies used to implement a PPC program and how the referral times, coordination of care, communication with other hospital services were improved while providing compassionate/holistic care to children with life-limiting and threatening diseases and in end-of-life. The implementation of this program has required the onset of specific strategies and arrangements to promote awareness and education proving it a hard task, yet not impossible.
拉丁美洲在获得儿科姑息治疗和疼痛管理方面的差距仍然是一个未得到解决的全球卫生问题。为了改善姑息治疗（PC）服务的发展，传统上一直针对成人服务，而忽略了儿科人群。此类服务的例子很少，应该在科学文献中描述，以便向决策者和服务提供者通报中低收入国家（LMIC）可用于应对儿科姑息治疗（PPC）负担的各种护理模式。本研究的目的是描述在哥伦比亚卡利的一家三级保健大学医院实施儿科姑息治疗计划“照顾你”（TCY）的情况。
为 2017 年至 2019 年期间的 0 至 18 岁儿童及其家庭建立了一个项目数据库。对该项目进行了描述性分析，以评估该项目的影响和服务提供情况。根据自行设计的分类法，采用基于理论的方法描述了 PPC 项目，对理论层次和领域进行了映射。分析中包括了患者的临床结果。
自 2017 年以来，该项目已为 1965 名儿童提供了 PPC 服务。他们中的大多数人患有肿瘤，并从住院服务中转诊而来（53%）。2017 年至 2018 年，每季度门诊患者增加了 80%。同期，住院、急诊和重症监护病房的患者人数增加了 50%。
该项目填补了卡利地区儿童提供 PPC 服务的空白。它展示了实施 PPC 项目所采用的有效策略，以及在提供富有同情心/整体性关怀的同时，如何改善转诊时间、护理协调、与其他医院服务的沟通，为患有危及生命疾病的儿童提供姑息治疗。该项目的实施需要采取特定的策略和安排来提高认识和教育水平，虽然这是一项艰巨的任务，但并非不可能完成。
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