NECPAL 4.0 is a mobile application that allows estimating the risk of mortality in people with advanced chronic diseases to guarantee an early response to their palliative needs. It is aimed at all professionals who care for chronic pathologies, and is especially useful in Primary Care, nursing homes and Internal Medicine or Geriatrics services.
NECPAL 4.0 combines an evaluation of the perception of professionals based on the so-called “surprise question” (PS) –“Would you be surprised if this patient died over the next year?”– with the measurement of six objective parameters severity, disease progression, comorbidity, and consumption of services, selected for their prognostic value.
Thus, this application, developed by the Chair of Palliative Care at the University of Vic and SECPALestimates the risk of mortality in people with advanced diseases, allowing palliative intervention measures to be taken in advance if necessary.
The NECPAL 4.0 app allows the early identification of chronic patients with palliative needs
Based on the statistical procedure developed by the Chair’s team, and depending on the number of positive indicators presented by each person, a median survival of between 4.5 and 38 months can be established, which makes it possible to make a stratification of patients according to their prognostic stage.
In this sense, the Dr. Xavier Gomez-Batistedirector of the UVic’s Palliative Care Chair, points out that “The contribution of this instrument is very relevant, especially in the case non-oncological advanced chronic diseases, where there is generally greater uncertainty.
In this way, this application provides “a more precise estimate, even three or four years before the proper terminal phase” in chronic patients with more or less uncertain life prognosiswhich allows accelerating or not certain palliative intervention measures.
In addition, Gómez-Bastiste adds that “If the median survival of a person is relatively long, you have time to work on aspects such as the advance planning decisionsbut if the prognostic curve is lower, issues such as spirituality, mourningetc.”.
An app for professionals who care for chronic pathologies
The It is aimed at all professionals who care for chronic pathologies, and it is especially useful in Primary Care, nursing homes and Internal Medicine or Geriatrics servicesas well as in others where high proportions of people with advanced diseases are registered.
It is a practical tool that helps conventional health services to improve palliative care of people with chronic diseases and a limited life expectancy, by identifying their needs early and estimating a prognostic curve that facilitates the definition of the interventions they require at any given time.
In the words of Dr. Gómez-Batiste, “It is an instrument that starts from a general and comprehensive vision of palliative carewhich understands that any health system service that cares for people with advanced disease must improve the care it provides to these patients and, for this, it is necessary to start with its early identification”.
According to the calculations of the team led by the professor, the prevalence of people with palliative care needs in Spain amounts to 1.5% of the general population, but in most social and health services there are patients who require palliative care in variable proportions: 1% of the population cared for in health centers, 40% in acute care hospitals, up to 70% in residential centers and an even higher percentage in socio-sanitary.
Faced with this reality, the project is in tune with one of SECPAL’s priority objectives, that of guarantee citizens early palliative carenot only from the specific palliative care resources, but shared with the different levels of care in the health system.
Training course for the use of the application
To ensure that the application of this instrument in clinical practice is based on certain ethical, technical and procedural requirements, the and the consider it necessary to guarantee “a minimum of methodological training” on how to use it and interpret the results.
Thus, Dr. Gómez-Batiste explains that “The prognostic mortality curve obtained with the app is the result of a median risk applied to a population based on the factors it presents, but it is very important know how to interpret it individually and manage the results in each case”. Therefore, to use the NECPAL 4.0 app it is necessary to previously take the course ‘Identification of palliative needs to improve comprehensive and integrated care for people with advanced chronicity’, after which you will have access to download the app for your professional use.
This project is part of whose objective is ensure early and quality palliative care in cases of advanced chronicity through the effective coordination of the assistance devices available at the different levels of the health system.