1. Primary Palliative Care - Challenges and Resources. The Case of Switzerland Vanessa Alvarado & Brigitte Liebig University of Applied Sciences Northwestern Switzerland

2. Introduction Switzerland only recently started to focus on Primary Palliative Care (National Strategy 2013-15) large differences exist with respect to the legal status and implementation in Swiss cantons different attitudes towards life preservation, the alleviation of pain and other symptoms across regions lack of information and knowledge about the conditions of primary palliative care services 2

3. National Research Program 67 “End of Life” (www.nrp.67)www.nrp.67 Swiss National Science Foundation Project : ‘Decision making of General Practitioners in Palliative Care’ Family doctors play a key role in Primary Palliative Care Best symptom-management, advanced care planning, the collaboration with families, with ambulant services and medical specialists, pose highest demands on family doctors services and competencies. 3

4. Research questions Availability of ethic guidelines, recommendations and advance directives for general practice? Provision of support for family doctors by specialized care in clinics, nursing homes, hospices? by ambulatories, of mobile care teams etc.? Availability of training + further education in palliative care for family doctors? Financing of medical care services by family doctors? 4

5. Methods Case Studies in three Swiss cantons, situated in the German, French and Italian speaking part of Switzerland Expert Questionnaires with public health administrators and palliative care experts on national and cantonal level Expert Interviews with general practitioners experienced in primary palliative care 5

6. CONDITIONS of PRIMARY PALLIATIVE CARE in SWITZERLAND I 1) Availability of ethic guidelines + ADs a) visibility and use of guidelines for family doctors is rather small b) FPs are uneasy and unexperienced about using advance directives c) but also: generational changes! 2) Support by specialists and ambulant care services a) considerable cantonal differences in the provision of specialist palliative care and support by ambulant palliative care services, b) as well as between urban and rural areas c) lack of collaboration between specialists and general practitioners 6

7. 3) Support of competencies by education and training a) provision of training + further education varies regionally and across cantons b) no specific training for family physicians, time constrictions c) Some medical societies refuse or are restrictive with credit points for training in PC 4) Financing  poor financial support for palliative care by family doctors : PC activities are represented with a very short time limit  Important PC activities are not financed (e.g. coordination, family support, etc.)  poor financial support for important supply structures for primary palliative care (e.g. the coordination between specialized and primary care, family support, etc.) CONDITIONS of Primary Palliative Care in SWITZERLAND II 7

8.  still not enough visibility of guidelines or ADs in primary palliative care  support structures for primary palliative care vary heavily between cantons, between urban and rural regions  Due to a lack of formal education, primary palliative care is practiced still rather ‘hands on’  Palliative care provided at home is poorly financed  Small recognition of primary care services in Switzerland CONCLUSION – STILL A LONG WAY TO GO FOR PRIMARY PALLIATIVE CARE 8