The first unified official regulation of how to organize palliative care in Romania

Malina Dumitrescu, Program Director/PR, National Development Department and Education Programs, Hospice ‘’House of Hope’’, Braşov, Romania

Abstract

The Order of the Minister of Health (WHO) No. 253/2018 for the approval of the Regulation on the organization, functioning and authorization of palliative care services is the first formal unitary regulation in this field in Romania.

For 26 years, since the establishment of the first palliative care service in the country (Hospice House of Hope, Braşov), care for people suffering from progressive or incurable chronic diseases has developed along local initiatives, both in the public and the private system (as charity or private organizations), without the benefit of an organized framework and without being integrated into a coordinated development that provides unitary quality services. Due to this slow and random development of local palliative care initiatives, the degree of coverage of specialized palliative care services is still very low, while the need for it is high. Of the more than 172,000 cancer patients and other non-oncological patients who would need palliative care annually, only 9% now have access to these services.

The Order of the Ministry of Health creates the premises for the implementation and development of the World Bank’s program through which palliative care services will be expanded so that the real need can be covered as efficiently as possible throughout the country. The Order presents elements of a future development strategy for palliative care, so that the real need for palliative care services is covered as quickly and efficiently as possible in all counties.

Also, Order 253/2018 correlates with other legal provisions of the new Framework Contract for the years 2018-2019 and the Methodological Norms for its application, as well as with the quality standards required for the accreditation of health services by the National Authority for Quality Management in Health (ANMCS).

Palliative care will be available on three distinct levels:

Level 1 is that of educating and informing the patient and the family in order to be able to cope with the specific (chronic) progressive disease and its evolution, the different problems the patient and the family face.

Level 2 is represented by basic palliative care, which will be provided on all levels of health care, from family and community medicine, to general or specialist care, day care centres or specialised ambulant services.

It is anticipated that the staff of all health services, as the system develops, will acquire the basic knowledge needed in palliative care during education (faculties of medicine, healthcare, social assistance and psychology) in order to be able to treat patients who need basic palliative care.

Level 3 contains specialized palliative care, which is provided by multidisciplinary teams with in-depth training in palliative care: doctors with specialization and competency as well as complementary studies in palliative care, nursing specialists in palliative care, social workers, psychologists, therapists, spiritual counsellors). Specialized services are provided in different settings: at the patients’ home, in palliative care/outpatient departments, outpatient or in day-care centres.

Services known to the general public as “hospices” are level 3, i.e. specialized palliative care services. In the Order are detailed all the specialized interventions that can be provided in such specialized units/services: medical interventions, nursing interventions, social assistance and spiritual support services, medical services (psychological assistance and kinesiotherapy). Also, specialized services (level 3) of palliative care will be able to provide basic (level 2) advice.

For cases of low complexity, assistance will be provided at home or in family doctor’s offices. This Regulation envisages the progressive development of palliative care in Romania, as an integral part of the health medical system.

Key words: regulation, basic palliative care, specialized palliative care, hospice

(Full text in Romanian language)