Primary Health Care and Family Medicine reforms are well underway in BiH. A large part of BiH health services are moving away from specialist-centred, hospital-centred and doctor-centred healthcare towards comprehensive patient-cantered, community-based, integrated, continuous and multi-professional and multi-sectorial primary care. These changes have important implications, over and above for the patients.
End of life care is provided on an ad-hoc basis and without an existing system or community network and support. End of life care activities are not documented and covered by the Health Insurance Fund. FM teams lack training in the field of end of life care, equipment for home visits, while transport remains an issue. Cooperation with other sectors and actors in community depend on individuals and their good will. Pain management is not standardised and access to medication such as opiates needs to be improved.
Early 2016, the management of the municipal Primary health care centre Doboj approached the Foundation fami in order to conduct a feasibility study with the intent to develop a comprehensive, affordable and sustainable range of end of life services and support in Doboj. This initiative was supported and co- financed by University Hospitals of Geneva (HUG). We have started with an exploration of the different dimensions, needs and services associated with end-of-life care. Our common aim is a patient-centered approach, targeting quality of life, and offering a comprehensive, sustainable range of services and support.
Our thoughts are articulated around the quality of life of persons with an incurable condition.
The proposed approach consists of three phases:
• Phase I – Exploratory phase – Collecting needs and wants from identified patients
• Phase II – Preparatory phase – Gathering all stakeholders to develop a common solution
• Phase III – Implementation, evaluation and replication phase – Testing the model and Inclusion of Primary health care centre from FBiH
The chosen approach will help us confront our ambition for a comprehensive response to end-of-life needs with the reality of the FM teams, the caregivers, the social workers and all other stakeholders associated with patients suffering from incurable health conditions in the selected municipality.
Gathering reliable information and ensuring that care providers know what is important to the patient and their families are the foundation for driving change and supporting new efforts to better address the needs of terminally ill patients.
Therefore, before devising an acceptable, affordable and sustainable solution, we have hired patients and their families to tell us what barriers they have and what useful resources there are.