The number of Health Homes has grown in recent years, but not the number of Mmg and the level of competence

The Congress of the Emilia-Romagna Region of the Italian Society of General Medicine and Primary Care: From Health Homes to Community Homes, for Citizens’ Health. The new role of the family doctor

The healthcare system of the future needs a new model. A starting point can come from Emilia-Romagna, who after the Ministry of Health’s decree of 10 July 2007 established the so-called Houses of Health, social and health structures, which citizens can contact at any time to find answers to their health. problems., as well as finding acceptance and guidance among health and social services. However, this model remained incomplete due to the insufficient number of general practitioners and incomplete training. Boundaries identified with a proactive approach by the Congress of the Emilia-Romagna region of the Italian Society of General Practice and Primary Care, called “The Journey into the Profession as a General Practitioner in Emilia Romagna. Current Events and Perspectives Between Chronic Illness Management, Exercise and research ”, held today and tomorrow at Centro Servizi Didattici, Faculty of Medicine and Surgery in Modena.

“This congress is taking place a few days after the first PNRR deadline,” he says Claudio Cricelli, President of SIMG. We therefore open a first comparison with the definition and implementation of “Models and standards for the development of territorial assistance” which incorporates the so-called “DM 71” with the standards for territorial assistance. For the first time, standards common to all regions are defined under strict supervision of Agenas, which will soon present a first half-year report.DM 71 innovates in terms of solutions that have already been widely tested in this region.CdS – Healths Houses is the historical reference that today inspires CdC – Community Houses.This model finds, however, different declensions and developments precisely in the function of the new ministerial decree 71, which effectively redefines the old structures in the territory by introducing some innovations that will lead to a new evolutionary formulation of existing structures.The congressional debate will therefore propose a FIRST reflection on a document that tracks but does not dissolve the knot on the legal framework at all f or general practitioners and on the articulation of their activity, where there is still an open discussion going on between the government and the regions. One must remember – the chairman concludes – that the new experiments that will lead to the transition from CdS to CdC will probably take place precisely in Emilia-Romagna. Transition to be managed not only at the negotiation level, but in particular by opening a dialogue with scientific companies such as SIMG, which in our country guarantees the professional quality of primary health professionals “.

SIMG Regional Congress prepares the leadership for the challenges of transforming the healthcare system and the new care models. It is proposed as a program and as a promise. “We have some keywords – he explains Maria Stella Padula, SIMG Head of Modena and Professor of General Medicine at the University of Modena and Reggio Emilia – We talk about “Travel” and “Profession”, about chronicity management as taking responsibility in the public health service. We focus on research to evaluate the profession, to provide data and therefore value and merit to the care provided by the general practitioner, and to stimulate the continuous improvement of professionals. Another strategic point is education, understood as the recognition of the identity of the discipline “General Medicine”, so that it is taught in education, a step already taken at our university but not elsewhere “.

The Houses of Health or Community Houses between boundaries and potential

The activities in CdS are divided into integrated focus areas on the basis of aid intensity. Prevention and health promotion are planned; reproductive well-being, perinatal care, childhood and younger generations; population with occasional-episodic needs; prevention and management of chronic diseases; not self-sufficiency; palliative care network. Between 2009 and 2019, in Emilia-Romagna, 120 structures were built across the territory, tripled in 9 years (there were 42 in 2011): a trend that confirms the dynamics of the phenomenon. A study carried out by the National Board of Health and Social Affairs in the Emilia-Romagna region on the impact of these structures on the territory in the year 2009-2019 showed that where there is a Casa della Salute, access to the emergency room for reasons that do not require urgent action, a percentage that is close to 25.7% when the general practitioner works within them. At the same time, hospitalizations for pathologies that can be treated outpatient, such as diabetes, heart failure, COPD, chronic obstructive pulmonary disease and bacterial pneumonia (-2.4%). Also in this case, the effect is greater (-4.5%) if the general practitioner is present. In absolute numbers, the Nursing Homes have made it possible to prevent an average of about 6,300 admissions to the Emergency Department each year for inappropriate reasons; at the same time, 3,000 more home care services were provided. Also, according to data from 2019, there are around 1,900 general practitioners working in the reference area of ​​Case della Salute, of which over 500 are full-time within the structures. There were 260 free-choice pediatricians working in the reference area. Furthermore, these structures can count on about 430 nurses, 190 midwives, 60 social workers, in addition to other professionals, such as rehabilitation technicians, administrators, non-medical health professionals and other health and technical staff. Yet the mechanism still has limits to overcome. “The number of Health Homes has grown in recent years, but so has the number of GPs and the level of competence as well – emphasizes Maria Stella Padula – These structures have become places where chronic diseases are mainly dealt with. We hope these places really become health centers. We still need to show that they represent an effective model of community health care. Precisely for this reason, on the occasion of our congress, there will also be the participation of chronic patients (diabetics, heart patients, etc.) and relatives, to report life experiences with the disease, needs and suggestions, analyze the management at home of patients with dementia, neurodegenerative and oncological diseases “.

Doubts and questions from patients and relatives

The involvement of the main users of the services provided by the community centers leads to the emergence of the real needs of the area. This is evident from the contribution of Linda Giugni, foster mother of Emma, ​​11-year-old girl, severely disabled. “We need to understand whether changing care places also means improving care. We must work on a solid doctor-patient relationship, which is also inevitably linked to the care context. It is desirable that the goal is not only to reduce hospitalizations and access to the emergency room, but also to offer answers nearby, with doctors and nurses at home, new technologies and telemedicine, ”says Linda Giugni. “We therefore need an information campaign aimed at young people (schools, universities, volunteer centers), where they tell who the general practitioner is, what his competencies are, what prevention is, what a prescription or a” challenging, what is a Casa “della Salute or a community hospital, what is” territory “or social services” he concludes Donato Zocchi, Regional Secretary SIMG Emilia-Romagna.

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