Pain management and palliative care are not for everyone; inequalities also in child care – WWN

Pain management and palliative care are not for everyone;  inequalities also in child care – WWN

Of Maria Giovanna Faiella

600 thousand patients a year require palliative care (a set of interventions aimed at treating diseases with a poor prognosis). Only one in three cancer patients and 15% of children who need it have access to it. Pain therapy is also a denied right (especially in the South)

About 600 thousand people would need palliative careor – as the law 38/2010 – the set of therapeutic, diagnostic and healthcare interventions aimed at the active and total care of patients whose illnesscharacterized by unstoppable evolution and a poor prognosis, it no longer responds to specific treatments. Necessary care not only for cancer patients, but also for those suffering from chronic or rare degenerative diseases. It’s still: among minors, Alone
30 thousand children receive palliative carethat is, the 15 percent of the children who would need it, according to estimates by the Maruzza Lefebvre D’Ovidio Foundation. As for the pain therapytoo patients’ rights sanctioned by law 38 and by the Lea-Essential levels of assistance (the services that the National Health Service must guarantee to all patients ed), over a third of people with chronic pain receivedin a year, just a prescriptionwhile they are patchy i Pain therapy centers,
widespread especially in the North. These are some data from the analysis of the Salutequit Observatory developed, among other things, on data from the Ministry of Health, Agenas-Italian Agency for Regional Health Services, Aifa-Italian Medicines Agency, Italia Longeva.

Law disregarded

Our country was the first in Europe to pass a law (n.38/2010) to recognize the patients’ right not to suffer needlesslyThe treatment of pain and his measurementbut also the taking charge of family sufferingas well as predicting the training of professionals and an organization second clinical networks. However, the Salutequit Report notes, the latest report to Parliament on the state of implementation of Law 38 – which was supposed to be annual – dates back to 31 January 2019 and refers to the period 2015-2017, therefore there is a “gap” of information of approximately six years compared to the state of the art and the ability of the Health Service to guarantee a dignified life, without unnecessary sufferingpatients and their families.

Palliative care received by only one in three people who died from cancer

The 2023 budget bill has defined an important milestone: And
By 2028, palliative care will have to reach 90 percent of the people who need ithowever – as the Salutequit Report points out – the Court of Auditors found that in 2021 (latest data available) it was still the assistance provided to cancer patients through the palliative care network is highly insufficient: as soon as 5 Regions, all in the Centre-Norththey were capable of guaranteeing an adequate level; among the southern regions, only Puglia is close to the minimum threshold required, 35 percent. According to data from Italia Longeva, in 2022 only one in three people died from cancer had received palliative care assistanceor 61 thousand people.
Hence, according to the editors of the Report, the need for cbridge the gap between different areas of the country and not “miss” the 2028 appointment, restarting – as early as December 2023 – the publication of the annual report to Parliament on the state of implementation of law 38.

Pediatric palliative care: only for 15% of children in need

It’s not any better for healthcare little sick people in need of palliative care, just 15 percent of those who need it. Tonino Aceti, president of Salutequit, underlines: I am inadmissible data for a National Health Service that claims to put athe center the humanization of assistance. We expect concrete and decisive interventions in a short time, because those families no longer have time; Furthermore, we must adapt the offer to the real needs of the population. This counts and for pain therapywhich risks being a right only for those who live in the North – as shown by the distribution of centers and the use of drugs -, and for palliative carewhere still today we measure the trend
considering the assistance offered only to cancer patients which, according to European estimates, represent only 40% of adults who would need palliative care, while the the remaining 60% of those who need it suffer from non-oncological chronic degenerative diseases (from cardiovascular diseases to Parkinson’s disease) recalls Aceti. Which adds: To date they are not subject to evaluation in the new Guarantee System of essential levels of assistance: in other words, it is not a parameter for evaluating the performance of the Regions in their ability to guarantee the LEAs. So the Lea indicators must be updated of the Guarantee System, also inserting the capacity of guarantee palliative care and pain therapy for chronic non-cancer patients.

The pediatric palliative care network is absent in 8 Regions

The Salutequit Report then points out that, 13 years after law 38, based on Agenas’ findings, in December 2021 two Regions had not yet established the Palliative Care Network: Abruzzo and Marche. All existing networks have declared that they take oncology and non-oncology patients into their care, but 14 networks had not activated the accreditation procedure.
Still worse
for pediatric palliative care: the Network nwas not established in eight Regions: Abruzzo, Calabria, Lazio, Marche, Puglia, Sardinia, Umbria, Valle d’Aosta.

Pain therapy: what is it, the Centers (lacking in the Center and the South)

Then there is the chronic pain which many have to deal with for months, if not years. About one million Italians they suffer from severe chronic pain; if we then consider the moderate pain, there
figure doubles (reaching two million).
There pain therapyas defined by Law 38, theset of diagnostic and therapeutic interventions
aimed at identifying and applyingto chronic disease forms, t
pharmacological, surgical, instrumental, psychological and rehabilitative therapiesintegrated with each other in various ways, for pain suppression and control.
In the absence of institutional data, the census of SIAARTI (Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care) finds that in 2021 they were present in our country 305 Non-cancer pain therapy centerslocated heterogeneously across the territory: 164 in the North, 64 in the Center And 77 in the South.
Sabrina Nardi, from the Salutequit Observatory, explains: We know there is one disparity in terms of the presence of pain therapy centres but also – based on data from OsMed (National Observatory on the use of medicines) of Aifa – that theuse of pain medications
decreases as you move along the peninsula, from North to South, where the consumption of 6.2 Ddd (defined daily doses), or approximately 22 percent lower than the national average. Really in some regionssuch as Calabria, Campania, Molise, Sicily, the use of these drugs less than 6 Ddd.

One in three patients with chronic pain has only one prescription per year

Again, adds Nardi: Faced with a chronic pain to keep under control, like that neuropathic or a pain that one has to deal with even for years, It is striking that a third of patients had only one prescription during the year. And there
to percentage of c
sporadic consumers focuses to the south (37.8%, in Calabria it is almost 40%). The same OsMed Report underlines that data on the percentages of users with a single prescription indicate the need to disseminate and implement recommendations on the use of these drugs through professional training and specific audits
Therefore, according to Salutequit, the North-South and intra-regional differences must also be filled with respect to the consumption of appropriate and necessary drugs for the treatment of pain.

November 15, 2023 (changed November 15, 2023 | 08:15)

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