Current situation and perspectives of palliative care in Czech Republic

Czech palliative care 2010– an interesting and exciting topic for media and society discussion, searching compromise between „skilla and charibda“ ... euthanasia and dysthanasia – first of all on non-cancer palliative care field, never-ending negotiations with the decision health care makers and health insurance.

There is realized a high quality palliative care in Czech Republic but its accessibility is not wide and for majority of dying people. Sociological researches show a paradox of the society will for dying in natural patient environment (80% of respondents) and a real situation when ¾ of all deaths takes place in hospitals, nursing homes or senior houses. Unfortunately health care decision makers still do not support a development of mobile palliative care teams and the community care system.

Since 1995 till 2010 most of palliative care in Czech Republic was offered by hospices. Contemporary there are 14 inpatient and several mobile hospices (standing out of the insurance system) in CR. Most of them offer holistic, multidisciplinary palliative care with specialists in medical, psychological, social and spiritual field.

Table 1: Causes of deaths in Czech Republic – UZIS 2009, www.uzis.cz

	Deaths/year	% of total deaths
Cardiovascular diseases	40,598	38.7
Respiratory diseases	5,736	5.5
Neoplasms (cancer)	27,981	26.6
Accidents (unintentional injuries)	6,087	5.8
Endocrine diseases	2,211	2.1
Neurological diseases (stroke, degenerative disorders)	12,960	12.3
Digestive diseases (liver disease, cirrhosis)	4,743	4.5
Genitourinary diseases (kidney disease)	1,272	1.2
Communicable diseases (non HIV-related, septicemia, malaria, TB, dysentery, etc.	931	0.9
HIV/AIDS	6	0.006
Deaths associated with intoxication	1,086	1.0
Congenital malformations	145	0.01
Perinatal conditions	201	0.02
Other causes/Insufficiently defined conditions	991	0.9
Total deaths	104,948	100.0

Consuptions of opioids in Czech Republic in 2008– according to International Narcotic Control Board:

• Morfine 8.22mg/capita

• Fentanyl 0.356mg/capita

• Oxycodon 2.87mg/capita

• Pethidin 7.0mg/capita

Palliative medicine for non-cancer diagnoses: HIV/AIDS is not an important issue from the public health perspective in Czech Republic –400 cases are described in statistics. As for palliative medicine the patients with end stage disease are treated on specialized infection settings.

Palliative care in elderly is a big issue of Czech palliative medicine. First of all in the level of dementia and of course also a topic of care organization in nursing homes, GP's community care and social care environment is widely discussed. The wide discussion about nutrition, hydratation, personal and law ability of decision is going on – in professional and also social environment.

Education and perspectives: Pre-gradual medical education in palliative care is offered only at Masaryk University Brno. Czech society for palliative medicine negotiates for the enlarging of these activities.

Since 2004 the medical specialty „Palliative medicine and pain treatment“ is recognized in CR. Due to different goals the dividing of both specialties is prepared. Czech society for palliative medicine wants to realize the functional curricula in PM for different medical specialties (i.e. geriatrics, oncology, interne medicine etc.).

We lack PM curricula in post-gradual nursing programmes.

Czech society for palliative medicine was recognized 2008 in Czech medical association of Jan Evangelista Purkyne. We have identified several steps which are important for the development of multidisciplinary palliative care in Czech Republic.

Drug real availability:

• Improve motivation and education GPs

• The network of ambulatory PM specialists and hospital consultant teams

Policy:

• PM conception implementation into National Health Care plan

Education:

• Nurses curriculum

• PM curricula implementation into basic medical specialties

Implementation:

• Ministry of Health, Health Insurance Company negotiation

• Media presentation

All these questions are the part of Czech attempt to Budapest commitment process.