| Abstract | Prvo predavanje o palijativnoj skrbi održala je prof. dr. Anica Jušić 1995. godine, a deset godina kasnije, 22. srpnja 2005. osnovan je Palijativni tim u okviru Lige protiv raka Pule. Istarska županija je 2011 godine donijela odluku o povećanju financijskih sredstava za projekt palijativne skrbi (110 000 € godišnje) uz uvjet pružanja skrbi na cijelom području županije. U to vrijeme zakonska regulativa je dopuštala organiziranje palijative skrbi samo unutar primarne zdravstvene zaštite te je bilo potrebno odabrati model pružanja kućne/izvanbolničke palijativne skrbi. U tim okolnostima jedina je mogućnost bila organiziranja mobilnog palijativnog tima . Zatraženo je i dodatno financiranje pilot projekta palijativne skrbi od Hrvatskog zavoda za zdravstveno osiguranje koji je odobrio dodatnih 35000 € godišnje. U lipnju 2012. godine osnovana je Djelatnost za palijativnu skrb i Mobilni palijativni tim sa sjedištem u Puli. Pored educiranih članova volonterskog tima (neurolog, farmaceut i psiholog) priključili su se medicinska sestra volonter te koordinator volontera. Zaposlene su dvije medicinske sestre, dva onkologa, psihijatar, kirurg i jedan obiteljski liječnik. Osim kućnih posjeta, suporta obitelji, obavlja se i niz palijativnih intervencija: postavljanje nazogastričnih sondi, promjene traheostoma, kateterizacije, nekrektomije, supkutane infuzije, abdominalne punkcije i peluralne punkcije. Sve je veći broj konzultacija obiteljskih liječnika. Psiholog i psihijatar pružaju suport obitelji i tijekom žalovanja. Tim ima psihijatrijsku superviziju jednom mjesečno i nerijetko se događa burning out nekog od članova tima što upućuje na potrebu organiziranja još jednog palijativnog tima ali i organiziranja stacionarne palijativne skrbi. Županijski tim za palijativnu skrb ima ulogu koordinacije organizacijskih aktivnosti na regionalnoj razini i suradnju s ostalim tijelima regionalne i državne uprave. U timu su predstavnici upravnih odjela za zdravstvo i socijalnu skrb županije, zdravstva (ravnatelji bolnice i Istarskih domova zdravlja, Voditelj djelatnosti palijativne skrbi, bolnički i obiteljski liječnici, glavna sestra Istarskih domova zdravlja, predstavnici zdravstvene njege u kući, socijalne skrbi, volontera, Hrvatskog zavoda za javno zdravstvo, školstva i crkve. Ovaj tim djeluje u slijedećim područjima: razvoj palijativne skrbi na županijskoj razini, umrežavanje svih dionika palijativne skrbi (bolnica, dom zdravlja, socijalna skrb, crkva, školstvo, volonteri), definiranje modela pružanja palijativne skrbi (stacionarna, izvanstacionarna), evaluacija provođenja palijativne skrbi, stručna i medijska prezentacija projekta te financiranje. Cilj rada je utvrditi ostvarivost vizije daljnjeg razvoja palijativne skrbi u Istarskoj županiji. Vizija je palijativna skrb cjelovito prožeta u svim sustavima Istarske županije. Aktivno uključivanje u skrb svih elemenata u primarnoj zdravstvenoj zaštiti: timova liječnika obiteljske medicine, patronažnih sestara i zdravstvene njege u kući za svoje pacijente koji imaju potrebe za palijativnom skrbi. |
| Abstract (english) | The first seminar on the palliative care was held by prof. Dr. Anica Jušić in 1995. Ten years later, on the July 22 2005, the palliative team within the Cancer League of Pula was established. In the year 2011 the office of Istrian County has decided to increase funding for the project of palliative care (€110,000 per year), under the condition of care provision for whole county. At that time legislation has allowed the organization of palliative care only within the primary health care and it was required to choose a model of home/outpatient palliative care. In those circumstances the only option was to organize a Mobile Palliative Team. The additional funding for the pilot project of palliative care was requested from the Croatian Institute for Health Insurance, and it was approved in amount of additional €35,000 per year. In June of year 2012 the palliative care department and mobile palliative team based in Pula were established. In addition to the trained members of the volunteer team (neurologist, pharmacist and psychologist) the volunteer nurse and volunteer coordinator also joined. Two nurses, two oncologists, a psychiatrist, a surgeon and one general practitioner were employed. In addition to home visits and support for their families, a series of palliative interventions were carried out: nasogastric tube insertions, tracheostomy changes, catheterization, necrectomy, subcutaneous infusion, abdominal puncture and pleural puncture. The number of consultations of general practitioners was increasing. Psychologist and psychiatrist provided support to the families even during bereavement. The team has a psychiatric supervision once a month and the burning out of some members often happens, indicating the need to organize an additional palliative team, as well as the organization of stationary palliative care. County team for palliative care has a role of coordinating organizational activities at regional level and cooperation with other bodies of regional and national government. The team includes representatives of administrative departments of the County Health and Social Care, the health care (hospital directors and Istrian Health Centers), the head of the palliative care department, hospital and family physicians, IHC head nurse and home care representatives, social care representatives, the volunteers, the Croatian Institute for Public Health representatives, schools and churches. This team operates in the following areas: the development of palliative care at the county level, the networking of all stakeholders of Palliative Care (hospitals, home health care, social care, church, education, volunteers), defining the model of the Palliative Care provision (stationary, outpatient), evaluation of the Palliative Care implementation, professional and media presentation of the project, financing. The goal of the diploma thesis is to determine the feasibility of the vision on further development of the Palliative Care in Istria. The vision is for Palliative Care to be comprehensively present in all systems of Istrian County. Active integration into care of all the elements of primary health care for the patients who have a need for Palliative Care, like family medical doctors teams, medical nurses and home health care. |
