Still lacking the equipment and training to respond to the requests of a 1st level clinic; Regional Pulmonology is not adequate in terms of human resources and diagnostic equipment suitable for a 2nd level outpatient clinic for the most serious patients.
Palermo, 9 May 2022 – Le
Chronic obstructive pulmonary diseases (Bpco) represent real “social diseases”, of great economic impact whose cost reaches significant values and the diagnostic delay can lead not only to the persistence of disabling disorders, but also to the progression towards more serious forms that inexorably they affect the patient’s quality of life from various points of view (social, personal, occupational). Their prevalence in the population increases with increasing age with related social and health costs.
The resources coming from the National Recovery and Resilience Plan (PNRR) represent a great opportunity for everyone, first and foremost the sick, but how to best use them? How to reorganize the assistance chain? What to ask of the territory and what of highly specialized centers? How to implement complication prevention? And in all of this, how can innovation produced, introduced and correctly measured, find easy access to create value? The goal of this fifth meeting, ”
FOCUS ON COPD, NOTE 99: HOW THE SCENARIO CHANGES
“, With a focus on Sicilyorganized by
Healthcare Engine
, with the unconditional contribution of GSK and IT-MeDwas to answer these questions, with the support of the scientific community, patient associations, health professionals and institutions.
The data speak for themselves: theIstat in Italy estimates a prevalence of BPCO of 5.6% (15-50% of smokers develop BPCO) and indicate a mortality that accounts for 55% of the total respiratory diseases and is gradually increasing over the period 2010-2018.. This disease represents the 4th cause of death
(6% of all deaths); his incidence is continuously increasing due to various factors such as smoking, pollution as well as the gradual aging of the population. Ladherence to therapy remains absolutely unsatisfactory and above all low in the panorama of chronic diseases, settling in percentages not exceeding 20%.
Other numbers. Access to hospital for exacerbated BPCOs is considered an indicator of avoidable hospitalization through effective and timely care of patients in the area: in Italy the hospitalization rate per exacerbated BPCO was still 1.07 per 1,000 in 2020 and I’m the 12.3% hospital readmissions within 30 days after a first admission (Source PNE 2021).
“These data confirm the need for organized interventions to contain the dimension of the problem and encourage better management of cases in the area – he explained Salvatore Scondotto, Epidemiologist, Sicily -. Is critical reduce the burden of disease by controlling the main risk factors through primary prevention strategies aimed in particular at combating the spread of smoking and reducing exposure to passive smoking through compliance with the relative prohibition in living and working environments. From the point of view of assistance it is necessary strengthen integrated management paths in the area useful for containing avoidable hospitalization which from PNE source is attested in our country and severe forms e enhance the available evaluation epidemiology toolsthrough the integrated use of current health sources, for the monitoring and evaluation of the quality of performance. New Lea Guarantee System, allows to raise the quality and appropriateness of the services provided to users “.
“BPCO is a complex chronic disease, preventable, treatable and progressively worsening, correct management involves timely prevention, diagnosis and therapy interventions – he reiterated Santino Marquis, President of AIPO Sicily -. To achieve this, an integrated system between general practitioners and pulmonologist specialists is required. With Note 99, the AIFA bound the prescribing criteria of inhaled drugs to well-defined diagnostic criteria, in order to obtain greater appropriateness, also trying to bring out what has remained submerged in the BPCO. While appreciating these aspects, it cannot fail to be noted that the provision does not take into consideration two fundamental factors: 1) general medicine still devoid of equipment
and training to respond to the requests of a 1st level clinic (simple spirometry to perform FEV1 / FVC); 2) the regional pneumological reality inadequate both in terms of human resources (hospital and territorial), and of diagnostic equipment suitable for a 2nd level clinic for the most serious patients
i(global spirometry, Dlco, etc.). It is clear that the good intentions of Note 99 are destined to fail if these knots are not untied “.
Therefore, according to Santino Marchese, a correct application of Note 99 requires: “a quickly different organization of general practitioners, in order to make up for the inadequacies noted above; aadequate pneumology network organized with 2nd level clinics in order to make effective all the indications of Note 99, which aims to evaluate all patients diagnosed with BPCO and those with suspected BPCO. In the absence of all this, there will be a patchy health organization that will only lead to a situation of chaos, with patients who cannot be adequately assisted by the public service and mortified pulmonologists will not be able to carry out their specialist work “, concluded Marchese. .
The positive aspects of the Aifa Note 99 have been highlighted by Franco Magliozzo, Provincial Secretary SIMG Palermo. “The Note shows a considerable tolerance on the timing of the evaluation by the pulmonologist specialist, so much so that in newly diagnosed patients it is allowed not only to perform a spirometry at the end of the acute phase, but if the FEV1 is <50%, we have six months to refer the patient to the specialist. If the patient is already being treated, then the times are extended up to 12 months, however, a previously performed spirometry can be reused, which allowed us to prescribe the appropriate therapy. Note 99 therefore reiterates the importance of spirometry in the diagnosis and follow-up of BPCO but defines the precise times within which it must be performed or requested. A very positive aspect, in my opinion, is that, spirometry performed, we can choose the most suitable therapy, defining the severity of BPCO, based on the symptoms he presents, the evaluation of the mMRCeCAT questionnaires, the presence of exacerbations or hospitalizations, bringing the general practitioner back to the central role of clinician. Note 99 also has the merit of having eliminated the therapeutic plan for double bronchodilation, offering the patient a therapeutic possibility on the part of his general practitioner, previously relegated only to a specialist field. It is true that there are still some critical issues, and I am referring to the impossibility of performing spirometry by some patients, even if the Note contemplates the permanent contraindications of people with severe cognitive disorders or disabilities and temporary contraindications. Finally, given the criticalities of the area, it is necessary to invest in its strengthening, in terms of personnel and equipment and at the same time, invest in the training of general practitioners, equip them with an “intelligent” spirometer so as to be able to be decisive and perform what indicated in the same Note “concluded Francesco Magliozzo.
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