Fewer people are dying at home in Portugal despite investment in palliatives

According to a study by Portuguese researchers that involved 32 countries and analyzed the impact of the pandemic on deaths at home, Portugal is one of the countries where fewer people die at home.

Speaking to Lusa, researcher from the University of Coimbra Barbara Gomez explained that this was the largest study of international trends on this topic, and also the first to show the impact of the pandemic at a global level in most of the countries studied. , welcome back to death at home.

The researcher believes that the data from Portugal is “reflective of a highly hospital-centric system” – where health care is heavily focused on hospitals – and that it already showed a lower percentage of deaths at home than in other countries before the pandemic.

“We were not surprised that, on the one hand, the percentage of deaths at home in Portugal was one of the lowest and that we also saw a decrease in the percentage of deaths at home both before and during the pandemic,” he said. The expert, however, stressed that the researchers expected to find some changes in the national data, which did not happen.

“We know that we have had investments in the palliative care space, both at the social media level and at the social media level. [Serviço Nacional de Saúde] as well as some private initiatives such as the Humaniza program. [da Fundação ‘la Caixa’] and so we would like to look for some changes in this sense, which did not seem to exist,” he explained.

An international study led by a researcher from the University of Coimbra and Silvia Lopez, a professor at the University of Nova de Lisboa (National School of Public Health), analyzed mortality data for more than 100 million people over the age of 18. ., between 2012 and 2021.

During the period 2012–2013, the percentage of deaths at home in the included countries was 30.1% (27.4% in Portugal), increasing to 30.9% in 2018–2019 before the pandemic, in contrast to what happened in Portugal. causing the value to drop to 24.9%.

In the last period analyzed (2020–2021), during the Covid-19 pandemic, this value continued to fall in Portugal (23.4%), contrary to the behavior of other countries, where the percentage of deaths at home rose to 32, two%.

“Especially in the field of palliative care at home, [o investimento] may not be enough to cover everyone in need,” admitted Barbara Gomes.

According to data published in December by the newspaper Público on national palliative care coverage, estimates indicate a need for 126 social workers, 128 psychologists, 181 doctors, 354 nurses and 92 surgical assistants.

Regarding causes of death at home, researcher Barbara Gomez said that, unlike most other deaths, cancer deaths at home have increased in Portugal.

“In this group, we recorded an increase in home deaths before and after the pandemic, which can be explained by cancer being a disease with a more predictable trajectory, as well as earlier and better integrated access to palliative care,” he said.

He also advocated the need to think about palliative care for “non-cancer patients” such as people with dementia.

He believed it was important to “reflect on the situation in Portugal in an international context”, ensuring that “health effectively follows people to where they want to be.”

“If the changes we are seeing in countries around the world – increases in mortality at home – are properly supported, consistent with preferences (…) and if they are associated with good outcomes, well-controlled symptoms, higher quality of life and comfort, then we will be on the right track,” he said.

However, he reminded, “if, on the other hand, there are gaps in end-of-life care, with the risk of patients and their families failing at home, then we must rethink and improve home-based end-of-life support.” .