Multidisciplinary TEAM, implementation of PTDAs, strengthening of the Hub and Spoke model and training for healthcare personnel. These are the 4 cornerstones of the new vademecum for the treatment of a serious pathology that often accompanies autoimmune rheumatological diseases: pulmonary interstitial disease (IDL).
The vademecum
The document, “Vademecum RETE ILD”, was drawn up by a group of specialists – rheumatologists, pulmonologists, radiologists and internists – and representatives of patient associations, who worked together for a year, and was presented during the conference. National of the ILD RETE project. Its realization is the result of an initiative conceived and promoted by Isheo with the unconditional contribution of Boehringer Ingelheim Italia. “It is necessary to set up multidisciplinary teams and implement PDTAs that allow the various specialists who have to interface to collaborate in a structured way, who must increase their expertise and their knowledge in the care and management of patients affected by autoimmune rheumatological diseases ”Explains Gian Domenico Sebastiani, Director of the Rheumatology Complex Operating Unit at the San Camillo-Forlanini Hospital in Rome.
Pain in one in two rheumatologic patients is not managed
Overcoming regional differences
The scientific evidence shows that the multidisciplinary team improves the prognosis of patients and the management of their disease. In Italy, however, there are objective difficulties of inhomogeneity: “Also for this reason the development of Hub and Spoke centers, at the level of the various regional and sub-regional realities, is very important – continues Sebastiani – and it is equally fundamental to establish the methods of referral and facilitate collaboration by building a network “.
Pulmonary interstitial diseases, too many differences between Northern and Southern Italy
Training and information
Another important aspect for the realization of an early diagnosis for rheumatic patients with ILD is the training “It is necessary to train the new generations of clinicians and multidisciplinary teams, which must be constituted with specific criteria, guaranteeing different skills”, says Carlo Vancheri, Professor Professor of Respiratory Diseases of the University of Catania: “Specialists must have experience because this disease is objectively difficult from a clinical and diagnostic point of view”. Last, but not least, the information that must be promoted at all levels: “From raising awareness of public opinion to that of managerial and institutional authorities – underlines the expert – and of those who establish health policies”.
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The role of the radiologist for early diagnosis
In early diagnosis, radiology plays a fundamental role: “The most important tool is high resolution CT”, explains Nicola Sverzellati, Director of the Operational Unit of Radiological Sciences, Department of Medicine and Surgery of the University of Parma: ” There are still some critical points to be resolved, such as the standardization of image acquisition protocols and patient exposure to the lowest possible amount of radiation. Radiologists must be able to recognize interstitial diseases even through tests that are not done for the study of interstitial diseases, such as for example in a CT scan of the abdomen that includes the bases of the lung “.
Why you need a PDTA
The picture shows, even more, the importance of having Diagnostic Therapeutic Assistance Pathways (PDTA): “We deemed a PDTA necessary for rare rheumatological diseases such as systemic sclerosis and rheumatoid arthritis” – says Silvia Tonolo, President of ANMAR Onlus – In Veneto there are currently four PDTAs on rheumatological diseases still in the approval phase and it would be interesting to include this part relating to lung problems within them. The PDTA tool was born in 2015, it was adopted by the State-Regions Conference and shortly after also the National Chronicity Plan (PNC), then transferred to the regions each in an uneven way (such as our health care) and included it in the Social Plans. Regional Healthcare (PSSR) but not adopted, others distorting the meaning of the plan itself. I appeal to the institutions, underlining that the implementation of a PDTA is a virtuous path for a patient with comorbidities and certainly has an advantage from the point of view of economic sustainability “.
Without forgetting the doctor-patient relationship
But patients also need effective communication: “This has prompted us associations to also ask clinicians to relate to patients in simple language, to interact with them through webinars”, underlines the President of GILS, Carla Garbagnati Crosti: ” patients ask to be the protagonists of their pathology, they ask to be informed and to be trained “. Also to understand and manage therapeutic innovation: “Innovating – concludes Paola Binetti, Secretary of the Presidency of the Senate and member of the XII Hygiene and Health Commission, who spoke during the Conference – also means recovering the relationship with the patient: having the ability to understand and use what can really be used “.