“Starting over with territorial medicine”, the appeal of young professionals: because the well-being of the community can make the difference

The pandemic, we’ve been saying this for days, has exposed the really weak link in our healthcare system: territorial medicine. What in reality should be the first point of reference for the citizen e the necessary filter to the hospital. Because diseases are not only treated in hospitals, meant for acute cases. All chronic patients should be assisted and treated at home or at most in nearby clinics. With the aging of the population, we are talking about important numbers, destined to grow more and more. The Steps monitoring system of the Higher Institute for Health Records in Italy more than 14 million people living with at least one chronic illness (heart disease, diabetes, cancer, hypertension, respiratory or liver disease, kidney failure, stroke or cerebral ischemia) and of these 8.4 million are over the age of 65. In this context, the campaign was born two years ago “2018 Primary health care: now or never” for the renewal of Italian primary care, signed by a group of young GPs, public health specialists, nurses and anthropologists. The reform proposal is contained in a “Blue book(The name is the same as the document prepared in 1990 byPortuguese Association of General Medicine and family with the guidelines on which the Portuguese health reform of 2005 was based), a document with 12 essential elements to start over to create a culture of primary care. Which indicates a new health model that is strongly integrated with the social sector and that puts the patient-person at the center, with interventions not only on the treatment of the disease, but also on the treatment of the person as a whole. As already provided since 2016 National Plan for Chronic Conditions of the Ministry of Health, unfortunately for these aspects still on paper in many parts of the country.

The core of the proposal (based on the National Plan) consists of development of a proactive and multidisciplinary approach “That is not limited to the provision of services aimed only at treating the diseases,” the document reads, but works in synergy with the community and the resources of the territory, in particular the social services of the municipality, local health authorities, pharmacies as well as associations, sports clubs, parishes, schools, condominium volunteers, to answer all patient care needs. Consider, for example, frail elderly in loneliness and economic hardship. “The GP employs a team of nurses, secretaries, psychologists and social workers,” he says Giorgio Sessa, one of the campaigners. The figure of the community nurse, introduced with the Health Pact 2019-2021 between the government and the regions, “must be accepted straight from the region, not by the GP, to avoid the far west of contracts and inequalities in treatment. In addition, Sessa argues, the physician should be paid not on the basis of the number of patients, but on the basis of health objectives, such as reducing the prescription of antibiotics or metabolic decompensation drugs by promoting a correct lifestyle. ”The Blue Book urges Also to strengthening the neighborhoods, that is the territorial articulation of the health companies. “Each district must be able to conduct an epidemiological survey of the territory to guide the range of services,” Sessa continues. And last but not least, the concept of integrated network: “It is imperative to build shared care pathways with specialists to deliver more personalized and less fragmented services. The GP cannot limit himself to making prescriptions, ”the young doctor insists.

Some realities are already experiencing this new social welfare. The home of health Piagge, located in the popular district of Florence, houses a group three GPs who have activated multidisciplinary work tables for a year with psychiatrists, social workers and nurses present in the structure. Where there is also a collection center, an obstetrician-gynecological clinic, a children’s clinic, outpatient specialists and public hygiene doctors. Cecilia Francini, 41, one of the primary care physicians, emphasizes the valuable usefulness of acting as a team. “Interventions are more topical and targeted. We have taken charge an elderly couple, he with dementia and violent towards his wife, we separated them, he no longer ends up in the emergency room, she is under protection ”. Another example: “Recently in two hours we placed a foreign woman on a welfare plan who had given birth for 20 days and passed out during a check-up by the gynecologist, had not eaten for a few days because she had no money. This is a multi-ethnic neighborhood with high unemployment, we see everyone, ”says the doctor. Managing Covid patients is also easier thanks to a group of colleagues. “We follow them in shifts, two hours a day – continues Francini -. We alternate with nurses for home check-ups or we use video calls, also to check chronic patients, after equipping them with a blood pressure monitor and pulse oximeter ”. Another initiative is the “proactive call” involve the community in building wellness. “During the phone calls to invite citizens to get vaccinated against the flu, we asked them if they had resources or contacts to support those in need – explains Francini -. The parish community has organized home delivery of food parcels to Covid patients or particularly vulnerable, one association provides transport to the hospital for scheduled visits, other volunteers call the elderly and lonely to find out how they are doing and if help is needed there are those who deliver drugs at home and with two associations we monitor the health status in the Roma camp twice a week to protect human rights ”. Nurses convert to “District nurses”, the doctor concludes: “ They will no longer have to work on tasks, nor on individual pathology, rather they will have to do with the well-being of the person at three hundred and sixty degrees, suggest physical activity or a cooking or vegetable garden course in solidarity with the neighborhood association as overweight or bad food. ”The most important solution this time too is integration with local sources.

Andrea Posocco, 33, is a general practitioner in Tarzo, a small town in Treviso with 4,000 inhabitants in the hills of Prosecco. “It is difficult in suburban areas to do group medicine because people are scattered” explains. The alternative is to work online. “We are two GPs across the country, we have decided to share patient medical records so that if one gets sick or overworked, the other replaces them.” This partnership has proved successful for Covid emergencies. Posocco has decided to establish his studio in the center of the municipality. “I meet weekly with social services. When I proposed this initiative, it initially seemed that there were no issues to discuss together. And instead, we both follow alcohol addicts, abused or abused people, or people suffering from psychological distress. Collaboration is fundamental, ”said Posocco, who, together with the city council, has also mapped local sports associations to involve them in promoting physical activity, especially for the elderly. “I could then refer my elderly patients to running groups or light gymnastics,” he explains. As he directs those in need to the psychological listening table activated by one of the two rsa. “It is free, intended for family members of people with dementia, but is generally open to all citizens.” Since July, the doctor has hired a secretary and a nurse with 1,600 patients: “Covid has made it clear to me that you cannot work well alone. The nurse does not limit himself to the standard care duties, he asks about the patient’s lifestyle and family support, whether he can receive the medicines, whether there is someone to remind him to take the therapy, whether he needs help to be washed, to shop, etc. Since last spring – Posocco concludes – a telemedicine project has also started with the diabetology of the Ca ‘Foncello hospital in Treviso. We do a video consultation with specialists to share treatment plans, jointly review therapies and patients no longer need to go to hospital to pick them up ”.

Source link