by Saverio Proia
30 SET – Dear Director,
a few days ago there was news of a bill establishing the family physiotherapist; for some time another one had been presented which favors, not the emulation of the medical accreditation model, but, in line with the choices of the Regions on overcoming the conventional model of employment relationship, the community physio-therapist as a professional assignment of dependent physio-therapists of the basic social and health district and therefore of the ASL.
In fact, while the PNRR with its consequent implementation obligations has provided for the implementation of the Community Houses as the backbone of the new territorial health after the tragedy of the current pandemic, the senator of the PD Paola Boldrini, Vice-president of the Hygiene and Health Commission of the Senate della Repubblica continues to outline the new and more advanced skills of the professionals and operators who will be the inhabitants and the protagonists; in fact, after an already extensive legislative production on the subject which I have dealt with in this authoritative newspaper, the senator presented the bill Senate Act 2339 “Establishment of the community physiotherapist”.
The motivation for this bill starts from the observation that health needs and with them, at the same time, rehabilitation needs have changed with the epidemiological transformation that has taken place over the last few decades; probably, their transformation will further characterize the picture in the coming years.
The reorganization of Primary Care, which is at the heart of the innovative proposals of the NHS, has as its reference model the fundamental elements of the Expanded Chronic Care Model (ECCM) in which the management of patients in chronic conditions is entrusted to a multi-professional team and coordinated by the General Practitioner (GP) and in this scenario of development of the ECCM, the need to decline the role of the Physiotherapist in the multi-professional group is highlighted: the integrated assistance to the chronically ill determines, in fact, the need for reorganization and “Reorientation” of health services in consideration of the natural history of chronic diseases.
These require health care that lasts for the entire life span of the person (continuity of care), an integrated approach of the different subsystems of the health service (territorial and hospital care) and the development of intersectoral alliances with those services. of society, which act the non-health determinants of health, in such a way as to affect the main risk factors.
Community Physiotherapy aims both at the prevention and at the improvement of the management of chronic / neurodegenerative diseases in all their stages, with expected positive effects both for the health of the citizens, and for the sustainability of the system itself (greater appropriateness of the paths and reduction of expenses welfare).
Furthermore, with the Community Physiotherapist, the strategies aimed at activating the person in the treatment process would be enhanced: creating truly “patient-centered” professional models and practices, in fact, means planning interventions that have among the objectives the empowerment of the person, with a view to long-term care.
In relation to interventions to support chronic and disability conditions and the maintenance of motor, cognitive and functional skills, especially in the elderly population, patient-centered proactive rehabilitation-educational actions prove effective in improving health conditions and in determine greater levels of appropriateness in accessing any rehabilitation services.
The text of the proposed law provides in the first article that the professional figure of the Community Physiotherapist is established, as a professional task assigned by the Local Health Authority to an employee physiotherapist health professional, with the task, within the specific articulations of the District of referred to in Article 3-quater of Legislative Decree 502/92, as indicated by national and regional legislation, within and in collaboration with the multi-professional Primary Care team, to identify and adopt the best strategies for prevention, evaluation, qualification and palliation, with the overall aim of contributing to improving the quality of life of the individual and his / her family or caregivers.
The second article specifies the skills of the community physiotherapist, providing that the same:
• collaborates with the multi-professional team in the assessment of community needs, in the elaboration of health profiles, in the identification of population groups at risk;
• supports health promotion through sectoral and intersectoral interventions targeting specific health determinants;
• favors the enhancement of community resources such as: volunteer groups, self-help groups, adapted physical activity, centers for the elderly;
• proposes the intervention in consultancy or in rehabilitation activities of other health professionals in the rehabilitation area in the presence of different health needs and consequent responses of rehabilitation services other than those pertaining to physiotherapy;
• promotes and supports:
• supporting self-care for individuals and their families in acquiring knowledge, skills and motivation in managing the disease, providing them with the necessary tools and regularly evaluating results and problems;
• the proactivity of the interventions in order to integrate the clinical and assistance activities is integrated with planned follow-up interventions, based on the path foreseen by pathology and according to the risk profile;
• support for the adoption of guidelines and best practices based on evidence to provide the team with the standards for optimal care for chronic patients and which are subject to constant updating, adaptation to the local reality and audits by part of the team itself;
• physical activity as a correct lifestyle, acting directly on “healthy” population groups or addressing people with reduced autonomy and / or in conditions of chronic non-specific pain, proposing motor activities adapted based on the assessment of the level of performance;
• the active involvement of the person and the caregiver in the care process and the promotion of self-management strategies for the disease, to significantly improve the quality of life and reduce the need for treatment;
• support of the professionals of the multi-professional team in identifying risk factors, both in healthy subjects and in subjects with chronic conditions;
• appropriate access to local and hospital rehabilitation services.
Therefore, it follows that the figure of the Community Physiotherapist has specific skills acquired with at least three years of professional experience that can also be integrated with post-graduate training, following the degree in the health profession of physiotherapist, focused on objectives and programs of health protection, which is in able to enable the professional to perform functions with direct assumption of higher responsibilities that are more complex and specialized than those envisaged by the professional profile governed by the regulation referred to in the decree of the Minister of Health 14 September 1994, n741.
Finally, in the third article it is specified that the employment relationship is dependent on the NHS and the methods of conferral, verification and possible revocation of the professional assignment of Community Physiotherapist, the consequent economic and regulatory treatment as well as the working methods also in derogation from the working hours method, providing for this purpose the work for projects and objectives.
It follows that the health companies provide, within the health districts referred to in article 3-quater of the legislative decree 30 December 1992, n. 502, the positions of Community Physiotherapist that pertain to the professional service for rehabilitation referred to in article 2 of the law of 10 August 2000, n. 251; the General Management of the local Health Authority of reference defines the number and objectives of the assignments referred to in the first period, to be achieved in accordance with the demographic and epidemiological status of the assigned territory and with the defined health objectives.
It is very logical and evident that although both the nurse and the doctor have a holistic vision of the person, they cannot do without other more specialized professionals in certain phases from social and health integration to prevention, treatment and rehabilitation, precisely for this last rehabilitation phase, the introduction of the figure of the community physiotherapist is all the more necessary for the nosological and demographic framework of the country, in order to perfect the territorial healthcare offer.
The establishment and consequent introduction of the community physiotherapist into the basic social and health districts and within them in the Community Houses has a great innovative value, given the serious shortage of professionals in the rehabilitation area starting with the physiotherapist, but equally lacking but o necessary are the other figures (speech therapist, occupational therapist, podiatrist, etc.) also in order to reduce hospitalizations, especially for people with chronic conditions, by building structured courses to respond in a complete and organic way to the rehabilitation needs of citizens with multidisciplinary teams.
Are they dreams of late summer? No, it is now widespread and shared opinion that this is the way to go and, therefore, an excellent law proposal that if approved and implemented could contribute to the ongoing reconstruction of local health as a strategic choice adopted for the strengthening of the NHS following of the devastation carried out with the current COVID-19 Pandemic and in any case it is already a strong contribution of ideas from which the Government and the Regions can make use of its innovative contributions in the implementation of the PNNR.
Saverio Proia
September 30, 2021
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