Health Plan, “A revolution for territorial medicine”

Franco Luca, referent of the ASP of Catania for Pnrr funds, speaks: “Getting closer to citizens”

CATANIA – The whole world of Sicilian healthcare is preparing to spend the 797 million euros that the NRR, the National Recovery and Resilience Plan, assigns to Sicily to build new works and health infrastructures. The health plan, approved two weeks ago at Ars, has given the green light to the implementation of hundreds of interventions that should give a great boost to the so-called local medicinethat is, those small and proximity structures that act as a first contact with citizens and as a filter towards larger and more modern structures, large hospitals in cities.

Community hospitals, community houses and territorial operations centers they will join the hospital network already approved in 2019, and should become the new reference points for citizens. But how will the new territorial health care work? What should Sicilians expect, and what problems could arise? He talks about it Franco Luca, contact person for the ASP of Catania for the Pnrr and director of the Department of territorial activities.

How will the health of the territory be

The possibility that comes with the funds of the PNRR is, for Franco Luca, that of relaunching Sicilian territorial health careof which both the limits and the potential have been seen especially in the years of the Coronavirus pandemic: “We can finally lay the foundations to bring health care and territorial realities closer – says Luca – by creating structures that have an impact on basins of 40, 50 thousand peoplewho know them well, who know how to take charge of their problems ”.

But how will community hospitals, community houses and other structures envisaged by the NRP operate? “These are structures where fragile patients are brought and taken care of – says Luca – in which there is a doctor, a specialist and a nurse 24 hours a day. Not only that, but these professionals could do both external and internal service, visiting patients at home who do not need to reach the community home, and making extensive use of the telemedicinewhich could be a great improvement: the patient, if he can, prefers to be followed at home, and with a good use of telemedicine we could create the domicile as a large widespread hospital wardin which patients are monitored with remote tools and doctors intervene when necessary “.

All this would serve communities of about 40,000 people, who would turn to the largest hospitals only in the most serious cases: “Coordinating the system and the transition from one structure to another – explains Luca – will be the local operations centers, which, for example, will report and follow the discharge of a patient from a hospital and his assignment to a community house . This is a process that already takes place today, in part and on some structures, but only on the initiative of the patient’s relatives. We have the possibility, instead, of structuring a system that takes care of all these things “.

What is needed

What does such an organization need to get started and take root? “First of all – says Luca – of study. It is necessary to know well the needs of a territory, for which it is known, for example, that 40 thousand people live in a certain area, that 12 percent are elderly, that among these there is a higher incidence of diabetes or a particular cardiovascular disease … Then on the basis of all this you can design and plan the services to be provided “.

Then we need the people who work in the structures: “Every actor, whether he is a doctor, a nurse or a specialist, must have his own role, and this can only be achieved with clear agreements. In addition, young doctors are needed, to be trained quickly, so as not to have to wait for them to finish their specialization to have fresh strength. In this way, among other things, we would launch young people immediately into the healthcare of tomorrow, instead of sucking them into old models ”.

Possible problems

What could hinder this new model of territorial health? “There are two types of problems – says Luca – the first is of a political and administrative nature: ministerial decree 71, which dictates the guidelines on the structures to be built, is not yet there. There is a draft that has not yet been approved, and therefore there is still some margin of uncertainty ”.

“The other problem is the staff – says Luca – who works in the structures? It is known that doctors, specialists and nurses are foreseen in the community houses, but how can you guarantee 24 hours of attendance? Under what conditions? You have to figure out which one with which concrete organizational model you want to set up the system, with, for example, a number of hours for each doctor to spend in the structures, other hours to spend on home visits and so on. Once these problems have been resolved, however, what we have before us is a great opportunity to revolutionize territorial medicine, making the family doctor go back to being a doctor “.

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