Daniel Gainza Miranda
SERMAS: Palliative Home Care Team, North Madrid
Telematic platform for consultation, coordination and training of primary care centers with the reference home palliative care Service
The palliative homecare teams (PHCT) in the Spanish health system have the objective
of supporting primary care teams (PCT) for the care of palliative patients at home
specially in situations of high complexity. In addition, its functions include training in
palliative care of PCT. In the Northern area of Madrid there is a great geographical
dispersion, which sometimes makes it difficult to coordinate the teams and the
training of PCT by specific teams. There are online communication tools that can help
to solve the problem of geographical dispersion.
Development of an on-line tool for the development of clinical sessions and workshops
between PHCT and PCT to stablish a coordinated care planning for all patients in our
program between PCT and PHCT and improve training in palliative care of PCT.
The implementation of online clinical sessions of coordination and care planning for
palliative patients between the PHCT and the PCT at least at the beginning of the
follow-up as well as the implementation of at least three formative workshops a year
on palliative care with a theme chosen by the health centers themselves.
Improve the palliative care attention at home in north area of Madrid through a better
care planning and improving training in palliative care of PCT.