Palliative Care Coverage across European National Health Systems: Proposal of a Synthetic Indicator
Abstract
:1. Introduction
2. Materials and Methods
2.1. Primary Indicators and Data
- Specialized palliative care services (SSPC) refers to the total number of reported specialized services per 100,000 inhabitants [13].
- Resources in other areas of the health system: Integration Capacity Score (ICS) refers to an indicator synthesizing PC activity in pediatrics, cardiology, oncology, primary care, long-term care, and volunteering. This score has a maximum value of 53 points and allows the classification of countries at a high level (score from 53–23), middle level (score from 22–11), and low level (<10 points) [2].
- The standardized need for palliative care for each country refers to the total number of patients who died due to SHS per 100,000 inhabitants in 2017. The burden of serious health-related suffering was based on the Lancet Commission report [18], using base mortality rates for 17 conditions from the WHO World European Mortality Database (EMD) [19].
2.2. Synthetic Coverage Indicator
2.3. External Validation
2.4. Patient and Public Involvement Statement
3. Results
3.1. Country Coverage Level (CCL)
3.2. External Validation
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Country | SSPC | ICS | Need PC |
---|---|---|---|
The Netherlands | 0.9 | 51 | 4.7 |
UK | 1.3 | 47 | 5.5 |
Germany | 1.1 | 43 | 5.9 |
Switzerland | 1.0 | 40 | 5.1 |
Belgium | 1.7 | 38 | 5.1 |
Czech Rep. | 0.6 | 36 | 5.9 |
Denmark | 0.9 | 36 | 5.4 |
Italy | 0.9 | 36 | 5.8 |
Poland | 1.5 | 35 | 5.5 |
Spain | 0.6 | 35 | 4.9 |
Austria | 2.2 | 34 | 5.1 |
France | 1.0 | 33 | 4.4 |
Kyrgyzstan | 0.2 | 26 | 3.7 |
Hungary | 1.1 | 25 | 7.9 |
Ireland | 1.9 | 25 | 5.5 |
Portugal | 0.9 | 25 | 5.9 |
Serbia | 0.2 | 23 | 8.7 |
Albania | 0.9 | 21 | 6.7 |
Romania | 0.6 | 21 | 9.1 |
Israel | 1.4 | 20 | 2.6 |
Lithuania | 1.7 | 19 | 7.9 |
Sweden | 1.6 | 19 | 5.0 |
Armenia | 0.2 | 17 | 6.1 |
Greece | 0.0 | 17 | 6.1 |
Luxembourg | 1.8 | 17 | 3.8 |
Norway | 1.2 | 15 | 4.4 |
Slovenia | 1.1 | 15 | 5.8 |
Moldova | 0.5 | 14 | 7.7 |
Russian Fed. | 0.2 | 14 | 7.4 |
Turkey | 0.2 | 14 | 3.2 |
Finland | 0.7 | 13 | 5.8 |
Tajikistan | 0.1 | 13 | 3.8 |
Ukraine | 0.1 | 13 | 8.3 |
Kazakhstan | 0.1 | 12 | 4.8 |
Malta | 0.4 | 11 | 4.4 |
Belarus | 0.2 | 10 | 6.6 |
Cyprus | 0.9 | 10 | 2.5 |
Latvia | 0.6 | 10 | 8.4 |
Slovakia | 0.0 | 10 | 0.2 |
Georgia | 0.6 | 9 | 5.6 |
Bulgaria | 1.4 | 8 | 10 |
Croatia | 0.8 | 8 | 7.6 |
Estonia | 1.4 | 8 | 6.6 |
Azerbaijan | 0.0 | 6 | 6.0 |
Bosnia & H. | 0.1 | 6 | 6.0 |
Iceland | 1.5 | 6 | 3.5 |
Macedonia | 0.3 | 6 | 6.8 |
Montenegro | 0.0 | 3 | 8.4 |
Uzbekistan | 0.0 | 3 | 2.5 |
Mean | 0.79 | 19.92 | 5.69 |
Std. Dev. | 0.60 | 12.45 | 1.92 |
Kurtosis | −0.830 | −0.397 | 0.494 |
Skewness | 0.383 | 0.758 | −0.197 |
Country Coverage Level | Specialized PC Services | Integrated Resources in the Health System | PC Need | Countries | |||
---|---|---|---|---|---|---|---|
N° Services per 100,000 | Integration Capacity Score (ICS) | Deceased Patients with SHS per 100,000 Inhabitants, Year | n = 49 | ||||
Level | Mean (Range) | Level | Mean (Range) | Level | Mean (Range) | n (%) | |
Advanced Coverage profile | ↑ | 1.27 (0.6–2.2) | ↑ | 31.45 (15–51) | ↓ | 5.32 (2.6–7.9) | 20 (41) |
Limited Coverage profile | ↓ | 0.38 (0–1.5) | ↓ | 11.67 (3–26) | ↓↓ | 3.18 (0.2–4.8) | 9 (18) |
Low Coverage profile | ↓ | 0.50 (0–1.4) | ↓ | 12.10 (3–23) | ↑↑ | 7.19 (5.6–10) | 20 (41) |
Country Development Level | Country | World Map of Palliative Care 2019 Level 1 |
---|---|---|
Advanced Coverage: countries with high scores on ICS, SSPC and low PC needs | The Netherlands | 4b |
UK | 4b | |
Germany | 4b | |
Switzerland | 4a | |
Belgium | 4b | |
Czech Rep. | 4a | |
Denmark | 4b | |
Italy | 4b | |
Poland | 4b | |
Spain | 4b | |
Austria | 4a | |
France | 4b | |
Hungary | 4a | |
Ireland | 4b | |
Portugal | 4b | |
Israel | 4b | |
Lithuania | 4b | |
Sweden | 4b | |
Luxembourg | 3b | |
Norway | 4b | |
Limited Coverage: countries with low levels of need and low ICS and SSPC scores | Kyrgyzstan | 3b |
Turkey | 3b | |
Tajikistan | 3b | |
Kazakhstan | 4a | |
Malta | 3b | |
Cyprus | 3b | |
Slovakia | 4a | |
Iceland | 4b | |
Uzbekistan | 2 | |
Low Coverage: Countries with high levels of need and low levels of ICS and SSPC | Serbia | 3b |
Albania | 3b | |
Romania | 4b | |
Armenia | 3a | |
Greece | 3a | |
Slovenia | 3b | |
Moldova | 3a | |
Russian Fed. | 4a | |
Finland | 3b | |
Ukraine | 4a | |
Belarus | 3b | |
Latvia | 4a | |
Georgia | 4a | |
Bulgaria | 3b | |
Croatia | 3 | |
Estonia | 3a | |
Azerbaijan | 3b | |
Bosnia & H. | 3a | |
Macedonia | 3b | |
Montenegro | 1 |
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Sánchez-Cárdenas, M.A.; Garralda, E.; Benítez, E.; Arias-Casais, N.; van Steijn, D.; Centeno, C. Palliative Care Coverage across European National Health Systems: Proposal of a Synthetic Indicator. Int. J. Environ. Res. Public Health 2021, 18, 10753. https://doi.org/10.3390/ijerph182010753
Sánchez-Cárdenas MA, Garralda E, Benítez E, Arias-Casais N, van Steijn D, Centeno C. Palliative Care Coverage across European National Health Systems: Proposal of a Synthetic Indicator. International Journal of Environmental Research and Public Health. 2021; 18(20):10753. https://doi.org/10.3390/ijerph182010753
Chicago/Turabian StyleSánchez-Cárdenas, Miguel Antonio, Eduardo Garralda, Edgar Benítez, Natalia Arias-Casais, Danny van Steijn, and Carlos Centeno. 2021. "Palliative Care Coverage across European National Health Systems: Proposal of a Synthetic Indicator" International Journal of Environmental Research and Public Health 18, no. 20: 10753. https://doi.org/10.3390/ijerph182010753
APA StyleSánchez-Cárdenas, M. A., Garralda, E., Benítez, E., Arias-Casais, N., van Steijn, D., & Centeno, C. (2021). Palliative Care Coverage across European National Health Systems: Proposal of a Synthetic Indicator. International Journal of Environmental Research and Public Health, 18(20), 10753. https://doi.org/10.3390/ijerph182010753