In a society that is progressively aging and whose needs have ended up in the background due to the emergency of Covid-19, the issue of chronicity is of central importance. Diseases that become chronic carry high costs, both socially and economically. It is therefore necessary to think of new models for the care of patients with cancer, HIV and liver diseases, a population with truly significant numbers.
Each year there are about 377,000 new cancer patients, 2,530 new HIV patients and 100,000 new patients with chronic liver disease: a situation that calls for new highly complex chronic patient care protocols.
It was discussed extensively in the session “Innovation and chronicization of diseases with a high social-welfare impact: oncology, HIV, chronic liver diseases” of the SUMMER SCHOOL 2021 organized by Motor Health.
With regard to infectious diseases, their management can be faced through new organizational models, as highlighted Francesco Menichetti, Director of the Infectious Diseases Unit, Pisa University Hospital, President of GISA (Italian Group for Antimicrobial Stewardship).
“The experience of Covid highlighted the need to create new organizational models for the management of infectious diseases, in particular for the implementation of the hepatitis C elimination plans, which have slowed down due to the pandemic, new models of taking care of patients with HIV and the need to invest in research for the elimination of hospital infections “.
Felice Alfonso Nava, Director of the Penitentiary and Area Health Unit. Dependencies of the ULSS 6 Euganea of Padua brought the Veneto model of HCV eradication to the discussion table.
“The Veneto region already in 2018 activated a control room in order to implement a plan for the eradication of Hepatitis C, also in light of the screening funding defined in the Thousand Extension Decree. Certainly a winning aspect of the Veneto model is the multi-professional collaboration between specialists and the territory, a modus operandi already consolidated in the oncohematological field. In the coming months, the activities envisaged by the Hcv elimination plans will resume ”.
From infectious diseases to tumors. According to Giordano Beretta, National President of AIOM (Italian Association of Medical Oncology), the chronicization of tumors is a big challenge, preceded only by the fact of being a great result.
“In oncology the world has changed – he continued – Metastatic pathologies that previously had a survival of a few months, now they can become chronic, reaching such long survivors as to hypothesize healing for metastatic patients, I am referring for example to melanoma. Change the prognosis of these patients and the approach to the system. The fact that this disease has become chronic creates the need to manage the history of the cancer patient in a different way: from the point of view of follow-ups, treatments, its management – more territorially than at the hospital level. All this requires the need to change the network system of oncology: to create a collaboration path on an organized basis ”.
Still in oncology “there is a need to manage chronicity through multidisciplinary teams” as he explained Gianni Amunni, ISPRO General Manager and Head of the Oncological Network of the Tuscany Region.
“The management of chronicity with regard to oncology highlights the need for multidisciplinary teams that work in synergy within the oncological networks to also optimize the use of resources and the appropriateness of use of high-cost therapies. Furthermore, it is not possible to have old organizational models to manage the new needs of the chronic cancer patient “.
He took stock of the high health costs associated with the chronicization of tumors, Alberto Bortolami, of the Health and Social Area, Pharmaceutical-Prosthetic-Medical Devices Department.
“Right now we have more patients accessing medical cancer therapy. We have new therapeutic diagnostic options and this is an innovative aspect. Fortunately, the disease becomes chronic more and more, towards a recovery. All this, however, entails increasing healthcare costs: 25% of oncological drugs out of the total expenditure. The AIFA report shows that in 2014 a patient cost 34.8 euros, while today a patient costs 65.3 euros, therefore 87% more. This is an aspect of sustainability that the national health system must somehow govern. We send 4 billion euros for oncology “.
“Oncology, HIV, chronic liver diseases are diseases with a high social and welfare impact that represent paradigmatic examples of highly complex chronicity – he explained Lucia Ferrara, Lecturer of Healthcare Management at SDA Bocconi School of Management -. The complexity of these pathologies is linked to the coexistence of multiple chronic conditions, high-cost technologies and specialized expertise to be preserved in diagnostic and / or therapeutic choices “.
According to Ferrara, today there are some pushes to change that are characterizing the debate and the transformation of services for these pathologies and the development of ad hoc models.
The first concerns the use of numbers and models Population Health Management.
“Developing population approaches requires the identification of the population through big data and corporate administrative databases, as well as segmenting the population and identifying deliberate models of care differentiated by target of need. The experiences that are spreading in various regional contexts, such as the ACG in Veneto and the Government of Demand in Lombardy, go in this direction, to connect the more central levels to the more corporate ones that generate the information ”he explained.
A second element is digitization and multichannel models. During 2020, numerous artisan experiences of telemedicine, tele-assistance, telemonitoring were developed.
“Multichannel management requires a paradigm shift, from a single offer model to offer models differentiated by patient target. This brings with it a clinical question with respect to which cases and which conditions can benefit most from remote services and a managerial question, in fact the organization and division of work changes and the operating conditions need to be rethought “.
Finally, a concrete and operational declination of taking charge is needed.
“Taking charge of the supply chain as governance requires the ability to connect the sequence of activities and the relationship between services and the possibility for the patient to benefit from an integrated response model” he concluded Lucia Ferrara.
source https://pledgetimes.com/chronic-diseases-a-health-and-economic-issue/
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