背景:有效的资助模式是实施和维持重症监护计划(如专业儿科姑息治疗(SPPC))的关键。在瑞士,资金问题经常被提出作为在专用环境中提供SPPC的主要障碍。然而,关于现有融资模式以及利益相关者面临的主要挑战的系统证据仍然很少。
目的:本研究的首要目的是调查和概念化瑞士以医院为基础的咨询SPPC计划的资助。其第二个目标是确定可持续资助这些方案的障碍和优先事项。
方法:4步流程,包括文档分析,用于概念化瑞士以医院为基础的咨询SPPC计划的资金。在与该主题的专家小组协商后,进行了3轮修改的Delphi研究,以确定与SPPC相关的资金障碍和优先事项.
结果:目前对医院咨询专业儿科姑息治疗方案的资助是复杂和分散的,结合来自公众的资金,私人和慈善来源。总的来说,21名专家参加了第一轮改良德尔菲研究,第2轮中的19和第3轮中的15。他们确定了23个障碍和29个优先事项。就12个障碍和22个优先事项达成共识(>70%)。在三个优先事项上达成了最高的共识(>90%):制定融资解决方案以确保SPPC计划的长期资金;为综合姑息治疗提供资金和支持;在高赤字姑息治疗患者的情况下,足够的住院服务费用报销。
结论:希望在瑞士进一步发展和扩大SPPC的决策者应该意识到,目前的筹资模式非常复杂,SPPC的筹资受到许多障碍的阻碍。考虑到患有生命限制疾病的儿童的患病率稳步上升,以及SPPC的有效益处,迫切需要改进筹资模式,以确保这一高度脆弱人口的需求得到充分满足。
BACKGROUND: Effective funding models are key for implementing and sustaining critical care delivery programmes such as specialised paediatric palliative care (SPPC). In Switzerland, funding concerns have frequently been raised as primary barriers to providing SPPC in dedicated settings. However, systematic evidence on existing models of funding as well as primary challenges faced by stakeholders remains scarce.
OBJECTIVE: The present
study\'s first aim was to investigate and conceptualise the funding of hospital-based consultative SPPC programmes in Switzerland. Its second aim was to identify obstacles to and priorities for funding these programmes sustainably.
METHODS: A 4-step process, including a document analysis, was used to conceptualise the funding of hospital-based consultative SPPC programmes in Switzerland. In consultation with a purposefully selected panel of experts in the subject, a 3-round modified Delphi
study was conducted to identify funding-relevant obstacles and priorities regarding SPPC.
RESULTS: Current funding of hospital-based consultative specialised paediatric palliative care programmes is complex and fragmented, combining funding from public, private and charitable sources. Overall, 21 experts participated in the first round of the modified Delphi
study, 19 in round two and 15 in round three. They identified 23 obstacles and 29 priorities. Consensus (>70%) was obtained for 12 obstacles and 22 priorities. The highest level of consensus (>90%) was achieved for three priorities: the development of financing solutions to ensure long-term funding of SPPC programmes; the provision of funding and support for integrated palliative care; and sufficient reimbursement of inpatient service costs in the context of high-deficit palliative care patients.
CONCLUSIONS: Decision- and policy-makers hoping to further develop and expand SPPC in Switzerland should be aware that current funding models are highly complex and that SPPC funding is impeded by many obstacles. Considering the steadily rising prevalence of children with life-limiting conditions and the proven benefits of SPPC, improvements in funding models are urgently needed to ensure that the needs of this highly vulnerable population are adequately met.