Every year in Puglia there are around 2000 terminal patients who need palliative care. Till today there have been heterogeneous levels of supply, so in order to face such demand the region intends to carry out a program of structural and organic interventions, in synergy with similar healthcare programs, such as the integrated domiciliary assistance, and in synergy with voluntary assistance activities, both operating and non operating within the Local Health Units.

  • Absence of Integrated Domiciliary Assistance (ADI) operating within all those districts where palliative cares weigh on the sick person and on his/her family nucleus, both in economic terms and in psycho-emotional and social terms.

  • Absence of treatment programs organized in accordance with the demand of the single patient and coordinated by a doctor specialized in palliative care, with consequent non-alignment of the assistance to terminal patients, in comparison to the international standards.

  • Absence of structures committed to palliative therapies that are not supplied at home (hospice).

  • Absence of collaboration between the Physicians of General Medicine and the Physician responsible of the supply of palliative care, that results in an answer quantitatively and qualitatively inadequate to the population needs.

  • Cultural Attitude for which the terminal phase of life does not have the same dignity of other phases of the human life and the Hospice could be considered as the place where one goes to die.

  • Lack of personnel properly trained for the global assistance (medical, spiritual, psychological) of terminal patients.

  • Absence of Professional Training Programmes for the medical, paramedical and of the voluntary staff.

  • Absence of integration among the various structures that attend to the << terminal patients >> and scarce coverage of Voluntary Associations in many districts.

  • Absence of Communication and Information plans.

The program defined as SIHOPU (Puglia Integrated Hospice System) intends to realize a regional territorial assistance network for the supply of palliative care, of which the residential centre (hospice) will constitute the crux and the coordination core of all the activities.

The network privileges the domiciliary assistance and makes available, if necessary, the residential structure personalizing the care course according to the clinical and family conditions of each patient, to whom the assistance continuity will be guaranteed.

  • To guarantee standards of health, quality and efficiency so as to satisfy, within the normative ties of the law 39, 29th February 1999, the demand of palliative care.
  • Territory spreading of the services.
  • To retrain - to reorganize - to improve the coordination tools of the citizens’ service net, also through experimentations of new managerial models.
  • To retrain and to enhance the technical and structural patrimony of the hospital network.
  • To strengthen both qualitatively and quantitatively the structural and technological medical equipment, with respect to the accessibility, to the safety and to the humanization of the assistance.

From the operational point of view, the Program will be developed in the following phases:

  • Harmonization of the single proposals reached by the Health Units with the program of structural and organic interventions expressed by the Region in the Healthcare Deliberation 2000/00106 of the 20.09.2000;

  • Identification of the centres in which to locate the hospices (8 beds in each one of the 12 Local Health Units), with special priority those definable as pilot modules;

  • Assessment of the conformity of the local proposals to the regional program for palliative care, to the regional decree emanated on necessity and to the relative operational protocol;
  • Set up of an operational regional multi-centre protocol for the evaluation of the network organizational model, validation of the supplied palliative care and formulation of the standardized operational procedures;
  • Professional training and selection of the personnel to involve in the network, promotion of the plan, according the modalities and methodologies already experimented by organizations operating in the field of palliative care;
  • Assessment of the results of the preliminary pilot phase;
  • Set up and organization of the executive plan of territorial development and of integration with kindred or similar services that can be supplied by other firms, included ecclesiastical ones, or that can be adapted and then conformed to the regional requisites, on the base of specific local demands revealed as necessary.

  • Systematic Approach of the activities of all the suppliers of palliative care to the customer services;
  • Awareness and information on the availability and typology of the services;
  • Attainment of the “cultural” critical mass so as to innovate towards the patient’s centrality in the process of supply of healthcare performances;
  • Availability, at the end of the experimentation (around 30 months), of fully trained personnel, standard and shared operational procedures, regional multi-centre experience.

The regional dimension of the program makes it necessary to produce an intense coordination and monitoring activity of the territorial networks, in order to favour the harmonic development of the Palliative Care Supply System. Thus it will be necessary to create an appropriate Unit that will coordinate, harmonize and monitor the activities of each single Local Health Unit, as well as analyse and elaborate the collected data, and transmit all the information to the Project Committee, constituted by the twelve Healthcare Directors of the Puglia Region and presided by the Regional Healthcare Coordinator.

  • Local Health Unit BA/3 - new construction to locate in the area of pertinence of the new Hospital of Altamura-Gravina4;

  • Local Health Unit BA/4  - Restoration of Hospital of Triggiano;

  • Local Health Unit BR/1 - << Restoration and reutilization plan of Villa Romatizza >> in Latiano;

  • Local Health Unit FG/1 - structure reconversion at Torremaggiore Hospital;

  • Local Health Unit LE/1 - Riconversion of n°8 bads of  RSA structure in San Cesario.

for further information please contact:

Dr. Elena Gianicolo

tel.  +39-0831/507338

email:  gianicolo@isbem.cnrsm.it
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