Compassionate communities: design and preliminary results of the experience of Vic (Barcelona, Spain) caring city

yesBackground: A program of Compassionate City or Community (CC) has been designed and developed in the City of Vic (43,964 habitants, Barcelona, Spain), based on The Compassionate City Charter and other public health literature and experiments, with the joint leadership of the City Council and the Chair of Palliative Care at the University of Vic, and as an expansion of a comprehensive and integrated system of palliative care. Methods: The program started with an assessment of needs of the city as identified by 48 social organizations with a foundational workshop and a semi-structured survey. After this assessment, the mission, vision, values and aims were agreed. The main aims consisted in promoting changes in social and cultural attitudes toward the end of life (EoL) and providing integrated care for people with advanced chronic conditions and social needs such as loneliness, poverty, low access to services at home, or conflict. The selected slogan was “Living with meaning, dignity, and support the end of life”. Results: The program for the first year has included 19 activities (cultural, training, informative, and mixed) and followed by 1,260 attendants, and the training activities were followed by 147 people. Local and regional sponsors are funding the initiative. After a year, a quantitative and qualitative evaluation was performed, showing high participation and satisfaction of the attendants and organizations. In the second year, the care for particular vulnerable people defined as targets (EoL and social factors described before) will start with volunteers with more organizations to join the project. Conclusions: The key identified factors for the initial success are: the strong joint leadership between social department of the Council and the University; clear aims and targets; high participation rates; the limited size of the geographical context; which allowed high participation and recognition; and the commitment to evaluate results

Prevalencia y características clínicas del dolor en pacientes con enfermedad crónica avanzada

Resumen: Objetivos: Determinar la prevalencia y las características clínicas del dolor en pacientes con enfermedad crónica avanzada, e identificar la frecuencia del dolor irruptivo. Diseño: Estudio observacional, descriptivo y transversal. Emplazamiento: Tres equipos de atención primaria y un hospital de cuidados intermedios. Participantes: Se seleccionaron todos los pacientes con enfermedad crónica avanzada. Mediciones principales: Se realizó una entrevista semiestructurada para recoger variables demográficas, clínicas y específicas de dolor mediante escalas validadas. Se registraron la ubicación (domicilio, residencia u hospital) y la trayectoria de cronicidad avanzada (insuficiencia de órgano, enfermedad oncológica, demencia o multimorbilidad). Se valoró la presencia de dolor según la Brief Pain Inventory (BPI) y, en los casos de demencia invalidante, según la Pain Assessment in Advanced Dementia (PAINAD). Análisis estadístico descriptivo y comparativo entre variables utilizando el programa R. Resultados: Se incluyeron 223 pacientes (60,4% de los seleccionados). Prevalencia del dolor: 83,9% (n = 187), sin diferencias según la ubicación ni según la trayectoria. Diferencias significativas en la intensidad del dolor según la ubicación (p = 0,0046) (moderado-severo en domicilio, moderado en hospital y leve en residencia) y según la trayectoria (p < 0,0001) (dolor moderado-severo en insuficiencia de órgano y multimorbilidad, moderado en cáncer y leve en demencia). Se observó impacto funcional por dolor leve-moderado, impacto emocional severo en el 41,5% de los pacientes (n = 51) y dolor irruptivo en el 8,6% (n = 13). Conclusiones: El dolor debe ser siempre explorado y evaluado en pacientes con cronicidad avanzada, ya que fue muy prevalente en todas las ubicaciones y trayectorias, especialmente intenso en la insuficiencia de órgano y en la multimorbilidad a domicilio. Apareció dolor irruptivo en trayectorias no oncológicas. Abstract: Objectives: Determine pain prevalence and clinical characteristics in patients with advanced chronic disease and identify breakthrough pain frequency. Design: Observational, descriptive, cross-sectional study. Location: Three primary care teams and one intermediate care hospital. Participants: All patients with advanced chronic disease. Main measurements: A semi-structured interview was performed to collect demographic, clinical, and specific variables of pain using validated scales. Patient location (home, nursing home or hospital) and advanced chronicity trajectory (organ failure, oncological disease, dementia, or multimorbidity) were recorded. Pain was assessed based on the Brief Pain Inventory (BPI) and, in cases of disabling dementia, using the Pain Assessment in Advanced Dementia (PAINAD). A statistical descriptive, comparative analysis between variables was performed using the R software. Results: Of all patients selected, 223 (60.4%) were included. Prevalence of pain: 83.9% (n = 187), with no differences based on location or trajectory. Significant differences in pain intensity based on location (P = .0046) (moderate-severe in patients at home, moderate in hospital patients, and mild in nursing home patients) and on trajectory (P < .0001) (moderate-severe in patients with organ failure and multimorbidity, moderate in patients with cancer, and mild in patients with dementia). Global functional impact of pain was mild-moderate, emotional impact was severe in 41.5% of patients (n = 51), and breakthrough pain was observed in 8.6% (n = 13). Conclusions: Pain must always be explored and assessed in patients with advanced chronicity, since it was highly prevalent in all locations and trajectories, being particularly intense in patients at home with organ failure and multimorbidity. Breakthrough pain was found in non-oncological trajectories