Sustainability and Resilience in the Italian Health System
8. Case Study 2 – Management of patients with multiple chronic conditions through community health centres: an organisational solution to ensure sustainability and resilience 8.1.1 Context In Italy, as in most countries with advanced economies, there has been an inexorable increase in the prevalence of chronically ill patients. This phenomenon arises from the demographic trend of population ageing (37% of the population is over 55 years and 23% is over 65 years), correlated with increased survival (life expectancy at birth equal to 85.3 years for women and 81 years for men1), the improvement of economic and social conditions and the rapid technological and scientific progress, particularly in the medical field. In Italy, approximately 40.7% (24.55 million) of the population is affected by one chronic disease4 at least, and those who suffer from multiple chronic conditions are increasing; in particular, 21% (12.67 million) of the national population is affected by two or more chronic conditions. The transition from health care based on acute management to one based on chronicity has necessitated the development of different tools to respond, in an integrated and territorial way, to the needs of the population. The integration at a structural5 and/or functional6 level guarantees at the same time the multi-professionalism and multidisciplinary nature of care and the coordination of patients in the different hospital-territory care settings to ensure continuity of care. In this perspective, the regions have defined health and social-health primary care interventions, which are different from each other but have three points in common: the redesign of the GP's role in the management of multidisciplinary and multi-professional teams; the coordination of health, social and health services and social assistance for the overall care of the patient; and the development of information and digital systems and telemedicine. The main models of territorial assistance structure that have emerged are listed below. In Lombardy, there are the territorial hospitals (Presidi Ospedalieri Territoriali - POT) and the territorial social health centres (Presidi socio-sanitari territoriali - PreSST)7 The first one comprises multi-service physical structures that provide medium- and low-intensity residential health and social health services for acute and chronic patients and outpatients and home care services. This structure offers residential health and social health services, including at least one of the following activities: §
hospitalisation for sub-acute patients;
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hospitalisation of intermediate-care patients;
§
medium- and low-intensity hospitalisation;
4
The four main groups of noncommunicable chronic diseases (NCDs) with relative mortality estimates in Italy in 2017 are cardiovascular diseases (35%), tumours (29%), neurological disorders (14%), chronic respiratory diseases (5%) and diabetes (3%). Global Burden of Disease Study 2017 – Institute for Health Metrics and Evaluation 5 Focusing on the physical place of hospital-territory integration in which to provide health and social assistance. 6
Focusing on the processes of passage and connection of patients in the different hospital-territory care settings through the coordination of all professionals involved in the management of the case. 7 Regional Law of Lombardia n.23 August 11 2015 42
