Frame
Covid-19 has highlighted what was already known, a strong hospital-centric trend of our enviable National Health Service (NHS). Therefore, great attention is being paid to local medicine because it is clear that general practitioners (Mmg) cannot operate individually, in the context of a medicine that is becoming more and more complex, without structures of a certain level and with a commitment inadequate storm. There are many opinions, and also many interests, in defining the functions and roles of these territorial structures, which should not ignore the good that has already been done experimentally in some Regions.
However, it may be useful to establish some premises. First of all, these structures, whatever they want to be called, must be public or built by non-profit groups. We must avoid the advent of the ‘private’ because profit determines a market that, having to always enlarge, is not conducive to private and public health. A second aspect concerns the need to avoid single formulas that are the same for the whole country. Activities must be established, but how to carry them out depends on the context, urban or mountain, that is, in areas with high or low population density. A third point concerns an attitude that does not believe that it already knows how to do it. Instead, it is necessary to think that community houses must be built from below by correcting errors, listening to the requests of citizens, integrating health and social aspects.
It would be a mistake to think that everything can be done quickly. If we want them to be efficient it will take a few years. Finally, it should not be forgotten that in the near future we will have a shortage of doctors, nurses and health workers. For this it will be necessary to increase the training structures, have all the staff full-time and dependent on the NHS, as well as increase the salaries which are among the lowest in Europe. To achieve the expectations of community houses it is necessary to concentrate all the activities existing in the area: from health to social, from municipal to those of the third sector (read: voluntary work and social cooperation).
The functions, certainly not easy because they are multiple and to be integrated, can be summarized as follows:
1) Prevention, a fundamental and essential activity for the sustainability of the NHS. Many chronic diseases (cardiovascular, lung, kidney, type 2 diabetes and most cancers) are preventable through good lifestyle habits. The community houses must be the main vehicle in support of the desired national and regional prevention campaigns. Reduce smoking, alcohol, drugs, use a varied but moderate diet. Do not gain weight, exercise physical and intellectual activity, at least 7 hours of sleep and so on. We all know what to do, but we don’t do it because there is a lack of convincing information, a school education and instead the medicine market prevails which, using advertising in an ambiguous way, wants to medicalise our society.
2) A filter. An efficient local medicine can represent a significant filter for emergency rooms which today are invaded by patients with minor problems to the detriment of those who really need them. It must also be a filter towards hospital admissions through the creation of relations between the territory and the hospital, today almost non-existent, due to the lack of trust between the respective operators.
3) The socio-sanitary. It means creating a closer relationship between community houses and home interventions. Chronic diseases that can be managed at home need an integration between health and social, public and third sector operators. Many interventions can be carried out at home with particular reference to the need to ensure help for the mentally ill who are now abandoned in their families.
To achieve these goals, personnel with adequate training are needed. More Mmg is needed to integrate with more specialists, present in outpatient clinics, and with family pediatricians, in order to gradually ensure outpatient clinics open 7 days a week and 24 hours a day. Alongside the doctors, obstetricians, nurses, psychotherapists and social workers must work in proportional numbers to the doctors present and to the characteristics of the territory. An efficient secretariat with a good computer system connected to the regional one is needed to have the data of all citizens available, stratified by state of health. They should also book diagnostic tests and hospitalizations. Community Homes should have equipment for routine analysis and also a telemedicine system that responds to various needs: performing tests remotely, communicating with the sick and their families, interacting with hospital specialists.
If these are synthetic notes regarding the role that community houses should have over time, it is clear the need for planning followed by an organization that needs managers at the level of the Regions mainly oriented towards results rather than compliance with procedures. The journey is long, but it must be started on the right foot by inviting doctors, health workers to participate together in the construction of community houses. Nothing good will be achieved without collective participation.
Founder and president of the Mario Negri Irccs Pharmacological Research Institute