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将姑息治疗纳入初级保健:印度姑息治疗协会与印度预防与社会医学协会的合作努力。

Integration of Palliative Care into Primary Care: A Collaborative Effort Between the Indian Association of Palliative Care and the Indian Association of Preventive and Social Medicine.

作者信息

Atreya Shrikant, Butola Savita, Bhatnagar Sushma, Kumar Dinesh, Muckaden Maryann, Kuraikose Jyothsana, Jeba Jenifer, Gupta Mayank, Palat Gayatri, Sanghai Pankaj, Mathews Lulu, Kumar Gaurav, Joad Anjum, Giri Purushottam, Kadri Amiruddin

机构信息

Department of Palliative Care and Psychooncology, Tata Medical Center, Kolkata, West Bengal, India.

Sector Hospital, Border Security Force, Tripura, India.

出版信息

Indian J Community Med. 2024 Dec;49(Suppl 2):S234-S239. doi: 10.4103/ijcm.ijcm_858_24. Epub 2024 Dec 30.

Abstract

India staggers at the 59 position (out of 81 countries globally) in the quality of death and dying index. A chronic life-threatening illness is often complicated by marginalized living, out-of-pocket health expenditure, illiteracy, and poor social support, and pushes the population further into the vicious spiral of suffering. The Indian Association of Palliative Care and the Indian Association of Preventive and Social Medicine joined hands in April 2023 to address the gap in the demand and availability of palliative care and proposed to empower Community Medicine physicians to provide primary palliative care. They put forth recommendations for education, service, and research developments in primary palliative care. In April 2023, the Indian Association of Palliative Care and the Indian Association of Preventive and Social Medicine joined hands to disseminate palliative care services to the community. Subsequently, a task force comprising faculties from Palliative Medicine and Community Medicine was formed. The position paper on primary palliative care jointly published by the Indian Association of Palliative Care and the Association of Family Physicians of India provided the framework for this position paper. The paper focused on education, service development, and research. The task force recommended the following: 1. Empower faculties and residents of the Department of Community Medicine, undergraduate students from medical and allied specialties posted to the department to provide primary palliative care. 2. Integrate palliative care into outpatient clinics (general OPDs in the hospital), community health centers, and home care as a part of the family adoption program. 3. Improve access to essential medications, including opioids, in urban and rural areas 4. Follow the recommendations of the National Health Policy 2017 to develop blended training programs for faculties and students. 5. Engage the community to identify patients with chronic life-threatening illnesses and allocate resources to support patients at home. 6. Collaborate to develop a protocol for regular audits and research for service improvisation.

摘要

在全球81个国家的死亡与临终质量指数排名中,印度位列第59名,情况不容乐观。慢性危及生命疾病常常因边缘化生活、自费医疗支出、文盲以及社会支持不足而变得更加复杂,这使得民众进一步陷入痛苦的恶性循环。2023年4月,印度姑息治疗协会与印度预防与社会医学协会携手合作,以解决姑息治疗需求与可及性之间的差距,并提议赋予社区医学医生提供初级姑息治疗的能力。他们提出了关于初级姑息治疗教育、服务及研究发展的建议。2023年4月,印度姑息治疗协会与印度预防与社会医学协会携手合作,向社区推广姑息治疗服务。随后,成立了一个由姑息医学和社区医学专业教师组成的特别工作组。印度姑息治疗协会和印度家庭医生协会联合发表的关于初级姑息治疗的立场文件为该立场文件提供了框架。该文件聚焦于教育、服务发展和研究。特别工作组提出了以下建议:1. 赋予社区医学系的教师和住院医师、在该系实习的医学及相关专业本科生提供初级姑息治疗的能力。2. 将姑息治疗纳入门诊诊所(医院的普通门诊)、社区卫生中心以及作为家庭收养计划一部分的居家护理中。3. 改善城乡地区基本药物(包括阿片类药物)的可及性。4. 遵循《2017年国家卫生政策》的建议,为教师和学生制定混合培训计划。5. 让社区参与识别患有慢性危及生命疾病的患者,并分配资源以支持居家患者。6. 合作制定定期审计和研究的方案,以改进服务。

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