Organizational issues and major problems of palliative care concerning treatment of end-stage renal disease in Polish residential hospices and hospital- -based palliative medicine wards

Copyright © Via Medica. Background. Patients diagnosed with end-stage renal disease experience a significant level of symptom burden, including pain, nausea and vomiting, inability to urinate, fatigue etc. At this point in disease progression, it is important to establish what types and choices of therapy are most suitable for these patients, in particular, the value of continuing dialysis treatment. Material and methods. A self-administered questionnaire was distributed among Polish residential hospices and hospital based palliative medicine wards. All responses obtained underwent statistical analysis using Pearson's Chi Square test. Results. Permanent palliative care facilities, from which 73 out of 166 registered in Poland, took part in the survey. ESRD patients were identified to be cared by 81% of the aforementioned institutions. The most common treatment approach for these patients was highlighted as conservative treatment (68%), followed by hemodialysis (47%), whereas merely 11% provided peritoneal dialysis. Differences between facilities were identified relating to therapeutic recommendations for terminal ESRD patients with residential hospices more likely to recommend dialysis in conjunction with palliative care, whereas palliative wards advocated a withdrawal from dialysis followed by the initiation of palliative care. Conclusion. All surveyed facilities considered ESRD patients eligible for guaranteed hospice and palliative care services. However, certain changes are needed to improve care for ESRD patients, including: The development of collaborative partnerships between hospices, dialysis centers and nephrologists, development of guidelines for withdrawing dialysis and applying conservative treatment, introducing better renal-based training for medical personnel as well as the introduction of transparency within rules relating to the financing of these services

Dialysis initiation, modality choice, access, and prescription: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Globally, the number of patients undergoing maintenance dialysis is increasing, yet throughout the world there is significant variability in the practice of initiating dialysis. Factors such as availability of resources, reasons for starting dialysis, timing of dialysis initiation, patient education and preparedness, dialysis modality and access, as well as varied \u201ccountry-specific\u201d factors significantly affect patient experiences and outcomes. As the burden of end-stage kidney disease (ESKD) has increased globally, there has also been a growing recognition of the importance of patient involvement in determining the goals of care and decisions regarding treatment. In January 2018, KDIGO (Kidney Disease: Improving Global Outcomes) convened a Controversies Conference focused on dialysis initiation, including modality choice, access, and prescription. Here we present a summary of the conference discussions, including identified knowledge gaps, areas of controversy, and priorities for research. A major novel theme represented during the conference was the need to move away from a \u201cone-size-fits-all\u201d approach to dialysis and provide more individualized care that incorporates patient goals and preferences while still maintaining best practices for quality and safety. Identifying and including patient-centered goals that can be validated as quality indicators in the context of diverse health care systems to achieve equity of outcomes will require alignment of goals and incentives between patients, providers, regulators, and payers that will vary across health care jurisdictions

Access to opioid analgesics in Poland - a brief analysis of the current regulation of opioids following recent legislative changes

© 2018 Polish Pharmaceutical Society. All Rights Reserved. The use of opioid analgesics commonly results in tolerance, dependence and addiction, requiring their classification as controlled substances. This, in turn, creates access barriers and increases the complexity of treating severe pain. The aim of this study was to provide an insight into the current legal impediments that limit opioid access in Poland, subsequent to recent changes in Polish legislation. Two methods were utilized. First, Polish legal acts relating to controlled medicines were analyzed. Following this, a short e-mail survey was distributed to pharmacy inspectors to identify the percent of community pharmacies that dispense opioid analgesics. There are a range of stringent requirements that control the use of opioids, and must be adhered to by medical staff. In Poland, every registered physician is authorized to prescribe opioids, and 90% of pharmacies must dispense these drugs. With regards to prescribing, the single or daily doses of opioids are not limited, and the amount of controlled medicine prescribed on one prescription is limited to 90 days use, in accordance with the dosage regimen. An opioid-based prescription is valid for 30 days. Other restrictions to opioid access are related to the storage, dispensing, usage and availability of controlled medicines. The barriers identified may limit access to opioids on one hand, but on the other, the changes in Polish law have alleviated the requirements for prescribing these medicines. Therefore, it is important to achieve an acceptable balance between the restrictions imposed on opioids usage and their adequate clinical application