What is palliative care?
Palliative care is the active and comprehensive care of patients who can no longer be cured. Palliative care prioritises the control of pain and other symptoms, and social, psychological and spiritual issues, considering that palliative care is interdisciplinary in its approach, involving the patient, the family and the surrounding community, ensuring that the patients’ needs are met wherever they are (at home or in hospital), with the aim of maintaining the best possible quality of life until death.
Palliative care for patients with certain diagnoses can be provided in an inpatient setting or on an outpatient basis – under the supervision of a general practitioner during home visits.
A patient co-payment is required when receiving services in a palliative care office, unless the patient is included in one of the groups of people exempt from patient co-payment. Patients receiving palliative care services in a hospital or at home do not have to make patient co-payment.
The decision about the palliative care required for a patient is made by the general practitioner or the attending medical specialist. The attending physician may decide to convene a board of physicians if the patient's treatment is complicated and requires the consultation or opinion of several specialties to decide whether to include the patient in palliative care.
Who receives palliative care?
Palliative care, including home visits by general practitioner, upon assessment of the patient’s health state, can be provided to patients with:
- human immunodeficiency virus (HIV) infection;
- malignant tumours;
- encephalitis (a tick-borne disease causing long-term disorders of the nervous system functioning);
- myelitis (inflammation of the spinal cord) and encephalomyelitis (chronic fatigue syndrome);
- diseases of the central nervous system;
- multiple sclerosis;
- diseases of the peripheral nervous system;
- myasethenia gravis (neuromuscular disease causing skeletal muscle weakness);
- heart failure;
- cerebrovascular diseases (brain disorders, for example, sequelae of a stroke);
- diseases of the oesophagus, stomach and duodenum;
- bed sores;
- damage to the spinal cord.*
Palliative care options in hospital
Palliative care in hospital can be provided:
1. after other hospital medical services, if the attending physician, having assessed the patient's state of health, considers it necessary to provide the patient with this type of medical assistance;
2. ja general practitioner or any other specialist has assessed the patient's health state and considers it necessary to refer the patient for first-time or repeated healthcare in hospital.**
For more information on medical facilities providing inpatient palliative care, please contact the National Health Service Customer Service Centre at nvd@nvd.gov.lv or call the information line 80001234. Telephone number for international calls +37167045005.
Palliative care options in outpatient facilities
Outpatient palliative care is organised by a general practitioner, who prescribes medication, if required, including painkillers necessary for the treatment, and issues referrals to healthcare professionals, including palliative care specialist.
The general practitioner has the right to do everything to relieve the physical, mental, existential, spiritual and social manifestations of the illness, which include:
- prescribing reimbursable medicines (strong painkillers, possibly opiates, etc.);
- use of methods to ensure pain relief and bed sore care;
- different measures required for shortness of breath, bleeding and other cases; wound care (cleaning and dressing);
- developing or revising a diet plan
- educating the patient and their relatives.
Patients requiring outpatient palliative care can receive a state-funded consultation of a palliative care specialist with a referral from the general practitioner.
For more information on medical facilities providing consultations of palliative care specialists, please contact the National Health Service Customer Service Centre at nvd@nvd.gov.lv or call the information line 80001234. Telephone number for international calls +37167045005.
Palliative care home visits
A general practitioner** or specialist may prescribe healthcare services at home for a palliative care patient if the person has restricted mobility that prevent them from attending a healthcare facility. Other healthcare services, such as vital signs monitoring, enema and investigations can also be prescribed.
Information on healthcare facilities providing state-funded home healthcare services is available on the National Health Service website in the section "Health Services" - " Healthcare Services at Home".
Palliative Care Offices
In order to ensure availability to palliative care, three palliative care offices have been set up in Latvia. Children are treated at the Children's Clinical University Hospital (BKUS) and Liepāja Regional Hospital, and adults at Daugavpils Regional Hospital.
The palliative care office at BKUS provides outpatient consultations and telephone consultations 24 hours a day, and palliative care services at home 24 hours a day are provided to patients registered with the palliative care office at BKUS.
The Liepāja palliative care office provides assistance for children, consultations of a paediatrician on palliative care are provided as well as assistance of a nurse, psychologist or psychotherapist. The Liepāja palliative care office provides consultations of a physician and a nurse for adults with a referral from a general practitioner in case of complicated issues.
The palliative care office in Daugavpils Regional Hospital provides consultations of a medical oncologist and consultations of an oncology nurse for adults.
For more information on palliative care offices, please contact the National Health Service Customer Service Centre at nvd@nvd.gov.lv or call the information line 80001234. Telephone number for international calls +37167045005.
There is currently registered guidelines in Latvia on paediatric palliative care "Clinical Guidelines for Paediatric Palliative Care" published in 2012, which aims to develop a unified approach to the diagnosis and treatment of pain and other symptoms, resulting in an appropriate quality of life for the patient.
You can find the guidelines on the website of the Centre for Disease Prevention and Control www.spkc.gov.lv in the section “For Professionals” – “Clinical Guidelines Database” – “Registered in 2013” – “Clinical Guidelines for Paediatric Palliative Care”.
*State-funded palliative care is provided to patients with the code of primary diagnosis B20-B24, C00-C97, D37-D48, G05, G12, G13, G35, G54.6, G55.0, G60.0, G61.0, G63.1, G70, G95.1, G95.2, G99.2, I50, I69, K22.2, L89 or T91.3 and the code of concomitant diagnosis Z51.5.
** Persons receiving healthcare at home or palliative healthcare in inpatient medical facilities within the scope stipulated in the Cabinet Regulation No. 555, as well as palliative care provided by a general practitioner during a home visit, are exempt from the patient co-payment.