Portugal’s data described as “reflection of a very hospital-centred system”
Portugal is one of the countries where fewer people die at home, according to a study by Portuguese researchers that involved 32 countries and analysed the impact of the pandemic on deaths at home.
Speaking to Lusa news agency, Coimbra University researcher Bárbara Gomes explained that this was the largest study of international trends on the subject and also the first to show the impact of the pandemic at a global level in most of the countries studied.
The researcher considered that Portugal’s data is “a reflection of a very hospital-centred system” – with healthcare very much centred on hospitals – and that Portugal already showed lower percentages of deaths at home than other countries before the pandemic.
“It didn’t surprise us 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,” said the expert, emphasising, however, that the researchers were expecting to find some change in the national data, which didn’t happen.
“We know that we have had investment in the area of palliative care, both at the level of the SNS (health service) and also some private initiatives, such as the Humaniza Programme (of the ‘la Caixa’ Foundation), and so we would have hoped to find some change in this direction, which doesn’t seem to have happened,” she explained.
The international study, led by the University of Coimbra researcher and Silvia Lopes, a lecturer at Universidade Nova de Lisboa (National School of Public Health), analysed data on the deaths of more than 100 million people over the age of 18 between 2012 and 2021.
In the 2012-2013 timeframe, the percentage of deaths at home in the countries included was 30.1% (27.4% in Portugal), having increased to 30.9% in 2018-2019, before the pandemic, unlike what happened in Portugal, which saw the figure drop to 24.9%.
In the last period analysed (2020-2021), during the Covid-19 pandemic, the figure continued to fall in Portugal (23.4%), a behaviour contrary to that of the other countries, where the percentage of deaths at home rose to 32.2%.
“Especially in the area of home palliative care, (investment) may not be enough to reach everyone who needs it in a significant way,” acknowledged Bárbara Gomes.
According to data published in December by the Público newspaper on national palliative care coverage, estimates point to the need for 126 social workers, 128 psychologists, 181 doctors, 354 nurses and 92 operational assistants.
With regard to the causes of death at home, researcher Bárbara Gomes pointed out that, unlike most of the other deaths, cancer deaths at home have increased in Portugal.
“In this group, we saw an increase in deaths at home before and after the pandemic, which can be explained by cancer being a disease with a more predictable trajectory and also with access to palliative care, earlier and better integrated,” she said.
She also defended the need to start thinking about bringing palliative care “to non-oncological patients”, such as people with dementia.
She added that it was important to “reflect on Portugal’s situation in the international context”, ensuring that “healthcare effectively accompanies people where they want to be”.
“If the change we’ve seen in countries globally – of increasing death at home – is properly supported, aligned with preferences (…) and if it’s associated with good results, with well-controlled symptoms, greater quality of life and comfort, then we’re on the right track,” she said.
However – she recalled – “if, on the other hand, there are deficiencies in end-of-life care, with the risk of failing patients and their families at home, then we must rethink and improve home support at the end of life.”
Source: LUSA
