The Regional Palliative Care Program (RPCP) is a community based model of palliative care services designed to increase access to high quality, cost effective palliative care services. The program has focused on providing access to palliative care support in the home and in all region health care institutions, while shifting the main area of end-of-life care from acute care, to home and hospice (hospices are in continuing or long term care facilities). As outlined in the objectives below, the program addresses clinical, educational, research and operational areas.

The Regional Palliative Care Program (RPCP) has been in operation since July 1995. Previously, access to palliative care services was inconsistent. Two palliative care units existed, one at the Edmonton General Hospital, and at the Misericordia Hospital. In 1992, 21% (290 patients), of all cancer patients dying in the region had access to these services. Palliative home care was also providing care in the community. In the 1999/2000 reporting year, access to palliative care consultation for cancer patients was 79.4% (Appendix 1). The RPCP has maintained this level of increased access through the community-based model of care every year since the program began. Although access to palliative care is reported for cancer patients, the program also supports patients with other diagnoses. In 1999/2000, ten percent of patients seen (126/1273) were patients with other diagnoses.

In 1992, 78% of oncology patients died in acute care hospitals, with an average of 20,000 patient days per year. In 1999/2000, the number of acute care days was 7639 a decrease of 14979 patient care days (Appendix 2-4). To meet this goal and sustain the decrease of acute care patient days, services were enhanced in the home, hospice and consultation to allow the transfer of care to
other settings.

Central to the program is a patient and family focus (Appendix 5), with outcomes outlining the direction of the program. The components of care; home care and family physicians, outpatient clinics, palliative hospice, regional consultants, acute care (referral hospitals) and tertiary palliative care unit are centrally coordinated by the regional office (Appendix 6). The education and research programs are coordinated with the activities of the Division of Palliative Care Medicine, Department of Oncology, University of Alberta. Patients and their families have access to palliative care consultants regardless of the care setting. The program has criteria for admission for each level of care (Appendix 7), assisting in the streamlining of care for patients.

An advisory committee representing stakeholders from the community, home care, continuing care, acute care, Cross Cancer Institute, Alberta Health, and family practitioners provided input into the design and early operation of the program (Appendix 8). This committee no longer meets, with regional input being accessed as required. A Regional Program Council for Palliative Care has been created and meets every 2 to 3 months.