Dying. It seems a grim topic for the first PHOnetic of 2010, however palliative care services in this district have matured and evolved and these changes deserve attention.
 
Palliative care embraces the physical, social, emotional and spiritual elements of wellbeing–tinana, whanau, hinengaro and wairua – and enhances a person’s quality of life while they are dying.

This district has been blessed with the care and attention GPs and nurses and Maori health workers have provided for their palliative care patients, as well as 30 years service from Dr James Carstens and his Gisborne Palliative Care team. 

Now a further palliative care focus has arrived in the form of the Liverpool Care Pathway. Some of you may already have started the training. At the same time Turanganui Primary Health Organisation’s own contribution to the care of palliative care patients (the Palliative Care Allowance) is underused and requires further study. 

PHOnetic journalist Helen Peterson spent the end of 2009 looking into this district’s palliative care services and draws together the regional landscape.

Keeping terminally ill people comfortable is vital if they are to be allowed to die with dignity in their own homes, but Turanganui Primary Health Organisation’s Palliative Care Service is underused.

Chief executive Keriana Brooking says latest figures show the service has assisted 25 percent less people during 2009, and there was a decrease in the number of Maori using the service.

“We don’t know enough about who is and isn’t accessing the service to understand whether seeing less people is okay.”

The PHO service saw its inception after a 2004 PHO review of palliative care services.

“One of the reasons for this review was because palliative care specialist Dr James Carstens was absent from work due to illness and this prompted the question: ‘What would happen if he left?’” said Keriana.

The review revealed two interesting points. Firstly, due to advances in medicine, people were living longer with illnesses that in past decades might have killed them. This meant an increased length of time people were defined as ‘palliative’.

Secondly, many local PHO general practitioners expressed an interest in maintaining contact with terminally ill patients for as long as possible before they moved onto specific palliative care service.

In response a new PHO Service to Improve Access (or SIA) was created, and called the Palliative Care Primary Care Allowance. This service pays for general practitioners to make up to 12 free home visits to a patient in the final stages of a disease. Patients’ families can also access specialized pain-management services and equipment through Gisborne Palliative Care Services to make care at home easier. 

During the first 18 months of the service 113 patients had used the free GP home visits; 75 percent of them were European and 21 percent were Maori. Since 2005, an average of 100 patients a year have used it, but it’s always been more non-Maori than Maori.

Keriana is concerned. 

“SIA funding has a target patient group - low income Maori and Pacific Island peoples with high health needs - these target groups have not traditionally been using the service.”

Since 2005 there have been no cuts to the PHO palliative care funding, so this could not be a contributing factor to the decrease in patients numbers, she adds.

The service had a lot to offer patients and their families but it could be better utilised. PHO staff are keen to find out what has been responsible for the drop in patient numbers and how access can be improved.