The future of territorial assistance Fedaisf Federation of Italian Associations of Drug and Parapharmaceutical Scientific Informers

We attended a local meeting in Anzola dell’Emilia, a commune in the hinterland of Bolognawho saw participation ofRegional Councilor Raffaele Doninialso Coordinator of the Health Commission for the Regional Conference, and by General Manager from Paolo Bordon Healthcare Company in Bologna. Interesting to better understand how we work on the new reform of territorial assistance, which with DM77 has become the law of the state. A reform that promises to change the face of our country’s healthcare system and try to imagine how it can be instilled in a substance of daily problems and extraordinary peculiarities.

First of all, in addition to greetings and thanks, it Mayor Giampiero Veronesi reveals it the project of the Community House of Anzola, funded by PNRRreceives an extra investment from the Municipality, which wants it to be even more responsive to the needs of citizens.

Even in the thriving and organized Emilia R.omagna the problems are not missing according to Dr. Cristina Maccaferri, Director of Primary Care del District, “We are in a moment of great transformation. The pandemic has changed the way we work, the relationship with patients, the way we communicate.”

In fact, we must not forget that we are thinking of the healthcare system of the future in the midst of a health emergency that is not time-bound. “I can testify to the great difficulties we had to face during the period of the pandemic – it says Dr. Barbara Saretta, family doctor and head of a core of 7 doctors – A colleague in the group retired a little in advance, but in a moment of great commitment. So we squeezed together and faced each other. We agreed to be present H12 as well as Saturday and Sunday by phone. But there has never been a break, and even today the sick are a huge number, which is why we had to restrict access to the clinic again “” We do not want to get sick: if in our group 5 people get sick, what would Spoon?”

Finding new primary care physicians that they are ready to settle is not easy and the problem arises in making themselves more “attractive”. The lack of medical staff is a major problem and it pertains not only to primary care but to all specialties throughout the national territory. With few doctors and many areas available, one of the features considered preferred is the provision of an outpatient clinic within local health facilities. This area actually boasts some very advanced conditions: the the presence of several group medicines, recognized a very important element during the pandemic, in addition to the fact that these are often organized with the study assistant and the secretary. Not only that, but Health centers they are already widespread in Emilia Romagna, which has 130 out of about 500 present throughout the country.

PNRR anticipates investments primarily in community centerswhich is the development of the House of Health ”- he says Paolo BordonGeneral Manager of the company – but with a strong integration between health and social services, plus voluntary associations that work with health professionals and are actually part of the system “” The challenge that is launched is a partnership between public entities to manage proximity to care. Bring healthcare, integrated with social services, as close as possible to the patient. The home may be the first place of careinvests more and more in territorial functions “

Chronicity management it is therefore one of the axes of reform. “From Fælleshuset, we will also be able to use advanced tools such as telemedicinegives opportunity for professionals to deal with specialists at the second level, and other figures are also given such asFamily nursewhich will be the general contact of the general practitioner in the management of the chronic patient, andCommunity nursewhich will work at a higher level and a wider pool, to enable easier integration between all professions and social services. “

It’s time forCouncilor Raffaele Donini: “Today we are thinking of the project for the healthcare of the future for the next 20 or 30 years in the paradoxical situation that we are still in a full emergency. The reforms that we are preparing and are already state legislation represent the prospect, the fruits that will be reaped in 3-5 years. But today we cannot divide, we must create a system, reject the exploitation of parts and examine bridge solutions. The themes are mainly three: General medicine, first aid, hospitals and especially some wards.

“The lack of healthcare professionals, even for those who represent expertise, greatly affects the present. Facing retirement and burnout we can not replace doctors. The lack of doctors and health professionals is a national problem and the result of 20 years of cuts in the health system. “

“The doctors, as represented here in Anzola, who work together, collaborate and help each other, represent an example at a national level. One could talk about interdisciplinarity also among GPs, each with its own specialty, its background, its experience. The comparison improves the diagnostic capacity and raises the level of care. “” When a so-called organ specialist and a person who knows the patient’s clinical history confront each other (think of telemedicine), the maximum performance we can produce is achieved. “

General medicine

“The prospect of dependency has been set aside for the GP – Councilor Donini continues – following the earthquake triggered by the proposal, how do we get over the bridge period? First of all, we must increase the ceiling brings it, as a suggestion, to 1,800 patients. So by using a state law, we can propose doctors in 2nd or 3rd year of training courses for general medicine, to take care of an average of 1,000 patients. Alternatively or next to this, we can find a place on the field continuity in care clinics, local doctorswho, however, are not general practitioners, with all that entails. “

“Then, no matter how many resources are made available to train new professionals, we must ask doctors to make an effort to address this transition period, which is already exhausted, what can we make available to enable them to work in the best possible way? Funding or structures for the administrative secretariat are being considered. Also to a nursing network that someone has already organized, at their disposal to reach the patient’s home. So we do our best and we will find a solution because the alternative that no one wants would be to leave citizens without a GP. “

The reform of the relationship with general medicine is already clear, has the consent of Fimmg, the Ministry of Health, the Regions’ Health Commission, so I think it could be presented by the government this summer. There is the problem of dosing the hours that doctors have to work in the structures, 18 a week, which makes them compatible with the heavy loads that the emergency puts on, but we are sure of an almost solution. “

In First Aid

We made a beautiful appointment at the emergency room, with all the union representatives, to initially alleviate the flight from distress and urgency. In the face of grueling shifts, strenuous work and incompatibility with the liberal professions, very few young people choose this difficult area. So we looked for solutions to make the emergency rooms more attractive, offer more career opportunities, recognize, with the formula of extra activity instead of overtime, virtually double pay, agree investments in more advanced performing equipment and above all try to create paths to remove patients recognized with white code from the emergency room, 75% of the accesses. How? One solution could be outpatient clinics with doctors in continuity of assistance, who pick up the white codes from the triage, currently inside the emergency rooms themselves, where we are ready in the common houses. “

Finally the economic theme. Those who want to make a good healthcare system need three things: funding because health costs so much, staff (and we have already said that) and good planning, as innovation can also be put well into good planning.

“Our region – concludes Donini – which has always been perfect so far, has been in constant deficit since 2020. Covid has drained hundreds of millions from the regions’ coffers, the management was the extraordinary commissioner and the regions have not yet received a refund. We do not want a new centralization or a push towards privatization. We want to take it back, we know how to do good. “

Editor’s note:

  • On it Community hospitals, the so-called spokes, only a few cards are mentioned, but as mentioned, the theme of hospitals is significant. It is difficult to think of a serious reform of territorial assistance that does not fit perfectly with an equally careful organization of the hospital network. (see Forum for hospital clinicians – Prof. Cognetti)
  • For analysis of the emergency room’s problems, common to many countries, is dedicated to a large literature (1), and the relevance seen from the results of a longer stay in the departments is also highlighted. We therefore find it difficult to remedy this serious situation, which is defined by some as the funnel of health care, regardless of intervention. upstream of the emergency roomto reduce the influx and appropriate, inside the emergency roomselect the problems well and guide the patients in the most suitable and fluid way, e.g. downstream of the emergency room, to ensure an adequate flow to the hospital wards for those patients in need of hospitalization (estimated at between 15 and 20% of admissions). (2)
  • The debate on the subject of ministerial decree 77 excites the minds of experts as much as it passes in silence in the “secular” press. We report the presentation of Dr. Domenico Mantoan, General Manager of AGENAS, the company responsible for monitoring the plan, and a document from the trade unions (CGIL, CISL) for a retaliation law.

(1) – Matthew Cooke et al. (editors). Reduction of attendance and waiting time in emergency rooms. A systematic review of current innovations [PDF: 550 Kb]. Reports to National Co-ordinating Center for NHS Service Delivery and Organization R&D (NCCSDO)2005.


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