1. Quantitative and qualitative analysis of the use of the opiates and satisfaction of recruitment standards of Palliative Care. Measurement of efficacy of the network of Palliative Care and Pain Control in the Local Health Unit No. 7 in Veneto (Italy). Authors: Dott. Cosimo De Chirico; Dott. Marco Luciani; Dott.ssa Paola; Dott. Sandro Cinquetti; Dott. Angelo Lino Del Favero.

2. Local Health Unit n° 7 Veneto (Italy) Veneto counts 4.948.931 inhabitants The Local Health Unit n° 7 guarantees medical care and social welfare for 214.048 people

3. Palliative Care Team The équipe is composed by: The general practitioner, who guarantees continuity of care and a good alliance with the patient and his family; A committed doctor, trained in palliative care, who facilitates clinical decision making and communication between the nodes of the network; Nurses, trained for the complexity of palliative care; Psychologist to support the patient and the care givers (family members or relatives) and the team members (burden of care, burnout).

4. Palliative Care Network Palliative Care Team Home Family Patient Hospital Welfare Home assistance

5. Palliative Care Network Instituted in 2005 with the task of coordinate palliative home care network. Since the construction of the hospice will be completed in autumn 2012, all data refer to our home care network experience. Project of Hospice “Casa Antica Fonte”

6. Quantitative analysis of the use of major opiates: Defined Daily Dose Source of data: Servizio Farmaceutico Territoriale ULSS n°7

7. Quantitative analysis of the use of major opiates: Equivalent doses of Oral Morphine (mg) Source of data: Pharmaceutical Service Report ULSS n°7

8. Consumption of Long Acting Major Opiates

9. Consumption of Short Acting Major Opiates

10. Long & Short Acting Opiates 49,02% 37,65% Rough estimate 2011 64%

11. Beginning of The Opiates Therapy: Way of Administration

12. Last Molecule Prescribed

13. Satisfaction Survey 2010

14. Recruiting

15. Network Reporting

16. Clinical and social impact of the network Death at home in 64% of patients; 92% of Care Time spent at home; Chemotherapy in the last month of life: 8% Vs 25% in Italian national average Total hospitalization rate in ULSS7: 2,5 x 1000 inhabitants Rough estimate cost of daily home care assistance is nearly 60 euro

17. Principles of The Law 38/2010 Focus on the patient, his family and relatives and the quality of daily living at home; Palliative Care Team that works on the territory in strict contact with the General Practitioner; Network to connect social and health services.

18. Palliative Care Committed Doctor Palliative Care Team Home Family Patient Hospital Welfare Home assistance Trainig on the field Care Alliance with the GP

19. CRITICAL POINTS, FUTURE CHALLENGES In 2008 the 43,4% of the patients followed by the Palliative Care Team deceased at the hospital admitted no more than seven days before the death; Since the autumn of 2012 the hospice will start working ; We work to be able to take in charge all palliative patients (oncological or not) in next few years.

21. Disclosure Statement of conflict of interest in the context of the subject of this presentation Within the past 12 months, I or my spouse/partner have had following financial interest/arrangement(s) or affiliation(s) below. Affiliation/Financial Relationship Company Support for travel Grünenthal Group Honoraria for lectures…………………… Honoraria for advisory board activities…………………… Participation in clinical trials…………………… Research funding…………………… Financial shares and options…………………… ……………………………..……………………