Inpatient and outpatient: palliative care development in Moscow

Inpatient and outpatient: palliative care development in Moscow
Photo: Press service of the Department of Healthcare
Moscow residents may receive palliative care services at home thanks to visiting services and at the Palliative Care Centre hospitals, hospices and palliative departments of city clinical hospitals.

According to the monitoring, 34,662 patients received palliative care in Moscow in 2018, with 14,358 of them at hospitals, as reported by the Minister and Head of the Healthcare Department Alexei Khripun at the meeting of the Moscow Government Presidium. 

By various estimates, 56,000 to 92,000 people need palliative care every year. It is provided to patients with progressive incurable diseases. A seriously ill person has the right to spend his or her last days of life without pain and fear.

Where to apply for help

According to the monitoring for 2018, adult patients could apply to 66 palliative care offices. They are open at 47 medical centres. In addition, there are ten visiting palliative care services for adults in Moscow and three visiting services for children, including the Beacon House, non-profit children's hospice service. Nine of them have been established on the basis of the Moscow multi-profile palliative care centre founded in 2015 to assist adult patients and their families. Two years later, in 2017, the Millionshchikova First Moscow Hospice with its seven branches joined in. The Director of the Centre is Anna (Nyuta) Federmesser, founder of the VERA Hospice Charity Foundation.

Palliative care for adults is provided in 11 centers, including the Palliative Care Centre with hospice branches (440 beds), departments open at multi-profile city clinical hospitals (240 beds), as well as at Psychiatric Clinical Hospital No.1 (360 beds).

Respiratory Therapy Centre

Last February, a 15-bed Respiratory Support Department was opened at the Palliative Care Centre. As of the end of 2018, 315 people have already received medical care, with 244 of them at home, after their relatives had been trained at the centre.

Specialists prepare patients to be transferred home after the critical and intensive care unit. In addition, the centre provides psychological support, train relatives to care for patients, help choose respiratory appliances (providing respiratory support).

At the end of last year, according to the coordination centre register, more than 900 people diagnosed with lung cancer, chronic obstructive pulmonary disease and amyotrophic lateral sclerosis potentially needed respiratory support. According to the decision of the medical board, all patients who required respiratory support (244 people) received necessary medical appliances in 2018. Mechanical and non-invasive lung ventilation devices were provided to patients under gratuitous use agreement.

Anaesthesiologists and resuscitators and other employees of the centre monitor appliances operation, and provide 24/7 respiratory support at home.

24/7 palliative visiting service (for adult patients)

Last January, the centre launched a visiting service that operated 7 days a week, and in September, a special team was formed to respond to the calls around the clock.

In 2018, the service specialists made 77,045 visits, which is 14,941 visits more than in 2017.

Anaesthesia availability

Since last February, visiting service physicians of the Palliative Care Centre and hospices prescribe drugs containing narcotic and psychotropic substances right at a patient's place. And since August 2018, visiting physicians are allowed to provide their patients with potent narcotic painkillers.

Coordination Centre 

On 1 April 2018, the Palliative Care Coordination Centre completed its trial mode. Patients and their relatives may get 24/7 medical advice by phone, e-mail, and through social media and messengers.

Within a year, Coordination Centre received 21,619 phone calls and registered more than 17,000 direct appeals for registration with the Palliative Care Centre.

The Coordination Centre collects data on all city patients who need palliative care, serving as a prototype of a system to register patients in need of palliative care for all other regions of Russia.

To get advice and register with the Palliative Care Centre

- call the Coordination Centre by phone: +7 (499) 940-19-48 or send an e-mail lifelist@zdrav.mos.ru;

- bring documents to the centre or any hospice or send them by e-mail lifelist@zdrav.mos.ru. Further, a doctor will visit a patient to check on his or her medical state and decide on the required scope and method of assistance.

Quality control

In 2018, a Quality Control Department was established at the Coordination Centre. It is primarily intended to provide regular objective assessment of the medical care level, communicate with patients and prevent flaws in facility performance. Within 2018, more than 650 surveys have been conducted as part of the palliative care quality control. The Department's employees have also been involved as experts for the general medical inspection of Moscow palliative departments.

Unified Hospital Admission Board

The Palliative Care Centre has a special Unified Hospital Admission Board. The employees of the branches (hospices) hold real-time discussions on the need for hospital admission or discharge of a certain patient. As soon as they decide to take a patient to a hospital, they look for vacant beds in departments or hospices, so as not to keep a patient waiting. It also ensures the continuous management of patients registered in the centre and receiving assistance at home or at a hospital.

Since September 2018, the Hospital Admission Board has been holding online meetings with all the branches involved. 

Patients transfer

Patients recognised as being in need for palliative care will be transferred to and back from the point of medical care free of charge. There were 6,143 patient transfers in 2018. It renders palliative care available to all groups of patients, saves both patients' money and time of ambulance crews. Previously, they had to visit patients who required palliative care, and those patients were often taken to ordinary hospitals.

Automation of palliative care processes

A technical specification for the Palliative Care module of the Unified Medical Information and Analytical System (UMIAS) has been developed aiming to integrate all palliative care system workers. This module is to be put into operation in 2020-2021.

Volunteer support

Last year, more than 2,500 volunteers participated in the Palliative Care Centre activities. To make their work more efficient, each hospice and centre engages special permanent coordinators. Together they assist personnel in all non-medical matters: they help with chores, make homey touches for patients’ comfortable stay, arrange various events and support incurable patients.

Training and development

A Personnel Training and Development Department has been established at the Palliative Care Centre. It holds internships, trainings and workshops conducted by leading experts. The Department cooperates with specialists from other organisations and regions.

It aims to improve palliative care knowledge and practical skills. Physicians have to know how to relieve the symptoms of disease, how to take care of and communicate with severely ill patients and their families.

The Workshop of Care, or school of care, for severely ill patients is one of the Training Department projects. The project was launched in 2018 at the expense of benefactors and the presidential grant.

Education and information support 

A hotline for terminally ill people, funded by benefactors and the presidential grant, is available by phone +7 (800) 700-84-36 to get psychological counselling or ask questions about patient home care, anaesthesia, protection of patients' rights, etc.

There are also information and training materials (leaflets, memos, manuals) published for patients, relatives and specialists on various aspects of palliative care (nursing, anaesthesia, psychological support), at the expense of charitable foundations with the participation of Palliative Care Centre and hospices experts. 

Palliative care for children 

Palliative care for children is provided at Morozov Children's City Clinical Hospital (30 beds),  Filatov Children's City Clinical Hospital (7 beds), Voyno-Yasenetsky Research and Practical Centre of Specialised Medical Care for Children  (30 beds). The latter is to be subordinated to the Palliative Care Centre in 2019 so as to establish the first Moscow Children's Hospice to be integrated into the city healthcare system. 

Out-patient palliative care is provided by visiting specialists of the Voyno-Yasenetsky Research and Practical Centre of Specialised Medical Care for Children and Filatov Children's City Clinical  Hospital. In 2018, the specialists of these institutions made 3,056 visits to young patients and 329 children received palliative care at home.

There is also the Miloserdie (Mercy) Assistance Service to help children. In 2018, its nurses made more than 600 visits to provide various types of palliative care. 

Beacon House Charitable Children’s Hospice provides the largest scope of assistance to children at home.  Currently, it is supporting about 566 families with terminally ill children living in Moscow and the region. From 2013 to 2017, the children's hospice visiting service operated entirely at the expense of benefactors. In 2018, the service was supported by the Moscow Government that allocated nominal subsidies. In 2018, the hospice service made more than 34,000 visits in Moscow and the region.

In 2019, a charitable children's hospice hospital is to be opened in Moscow. The idea of emerged in 2010. And in 2013, the Moscow Government granted a rent-free land plot and a building for a hospice hospital. Major repairs have been funded by benefactors. 

Cooperation with benefactors

The Palliative Care Centre and hospices operating as medical institutions are financed from the city budget. Work of coordinators, training of volunteers, non-medical individual assistance to patients is paid at the expense of benefactors. In 2018, this project was supported by the Moscow Public Relations and Youth Policy Committee.