The pandemic has taught us how the family doctor must be ready for interventions on the territory in the infectious field. We need a new scheme for taking charge of the Covid patient and proactively intervening in the fight against HIV and Hepatitis. Prof. Claudio Cricelli, President of SIMG: “We need to design a new training model based on greater awareness, concrete tools, the ability to intervene for early diagnosis and immediate application of appropriate therapy”
Rome, July 7, 2022
General medicine is trained on infectious diseases
To attribute to the General Practitioner a decisive role in the management of infectious diseases, starting from Covid-19 to get to HIV and Hepatitis. This is one of the needs that emerged with the pandemic: the effects, in fact, were not only on chronic diseases, certainly penalized for the reduction of checks and diagnoses. Even some infectious diseases, now chronic or treatable, have been neglected, while it is the family doctor who can play a decisive role in this.
From here a new training and information project starts. “We are starting to design a path for the new generations of doctors – underlines prof. Claudio Cricelli, President of SIMG – This process mainly concerns the so-called acute pathologies, sometimes underestimated by general medicine. As emerged with Covid, these today represent emergencies, they are part of daily life and patients come to the specialist when the opportunities for resolution have already been wasted. We must therefore design a new training model, based on greater awareness, concrete tools, the ability to intervene for an early diagnosis and an immediate application of appropriate therapy “.
The presentation to the Chamber
The project “We stand with public health: a call to action for infectious disease. Public health: present and future “, organized by Regia Congressi with the patronage of the Italian Society of General Medicine and Primary Care – SIMG and the Italian Society of Infectious and Tropical Diseases – SIMIT, was presented at the Press Room of the Chamber of Deputies on the initiative of the Hon. Mara Lapia, Member XII Social Affairs Commission Chamber of Deputies.
The introduction was by prof. Claudio Cricelli, SIMG President, and prof. Massimo Andreoni, Scientific Director of SIMIT. Alessandro Rossi, Project Coordinator and Infectious Diseases Area Manager SIMG presented the project. Ignazio Grattagliano COVID-19 SIMG activities coordinator intervened with “New organizational models for the management of Covid-19 patients”; Barbara Suligoi, Head of the AIDS Operations Center of the Istituto Superiore di Sanità, with “HIV as a chronic disease: integrated long-term health management”; Prof. Loreta Kondili, National Center for Global Health Higher Institute of Health HCV, with “The enlargement of screening programs”; prof. Marco Borderi, Medical Director of the Infectious Diseases Unit of the Sant’Orsola Malpighi Polyclinic, Bologna, with “The integration of services for an effective management of HDV”. The scientific journalist Daniel Della Seta will moderate.
The SIMG project for a new virus management
The SIMG project will be articulated over the next winter 2022-2023 through a cycle of four webinars focused on as many infectious diseases: Covid-19, HIV, Hepatitis C, Hepatitis Delta. A choice dictated by the function that the family doctor can perform. With regard to Covid, in addition to maintaining an important role in vaccinations, the GP will have to work on intercepting any complications, suggesting and rapidly prescribing therapies with direct antivirals or monoclonal antibodies to the most fragile patients, solutions that they maintained their validity despite the evolution of the variants.
For HIV it is possible to make the virus chronic, a concept summarized in scientific evidence U = U, Undetectable = Untransmittable, Undetectable = Not transmissible: HIV is not transmitted with the correct intake of effective antiretroviral therapy, which makes viraemia no longer detectable in the blood.
The hepatitis C virus, on the other hand, thanks to new therapies, can be permanently eradicated, in a few weeks and without side effects. For Delta Hepatitis, the most severe of the different hepatitis, the new molecule bulevirtide represents a revolutionary advance because it allows to treat patients who previously could not receive any therapy.
The problem for HIV, HCV, HDV is given by late diagnoses, which often come when the patient is already in AIDS (in the case of HIV) or on the way to serious cirrhosis or hepatocellular carcinoma in hepatitis. The undeclared is therefore considerable and screening is currently not sufficient.
“The role of the GP on these four infectious diseases must become proactive – underlines Alessandro Rossi – He must be a careful observer of the risk profiles of his patients he knows very well and establish screening interventions and, where necessary, propose vaccinations in fragile subjects. Naturally, territorial care must be revolutionized with new information, IT, personnel and network tools to alleviate the burden of hospitals and allow GPs to better manage patients at risk. The four webinars will be characterized by the contribution of various stakeholders: on the one hand there will be the scientific world, represented by SIMG and SIMIT, as well as by the health authorities; on the other hand, there will be a strong interaction with institutions, especially regional ones, whose commitment is essential to implement efficient screening and linkage-to-care programs. In the wake of these initiatives, SIMG will make instruments available to doctors that will be integrated into the GP’s file, who will be able to consult recent guidelines, updated laws, scientific analyzes, the Health Search scientific observatory. For General Medicine it will be a process of formation and integration “.
“The pandemic has shocked the whole world and has put public health in difficulty not only for hospitalizations, but above all in the assistance in chronic diseases – underlined prof. Massimo Andreoni – Among the chronic pathologies there are also infectious diseases that have this connotation. We have had great difficulty in assisting and screening for this type of disease. This suggests a shift from a predominantly hospital-centric public health system to a network between hospital and territory, so that what the latter can take charge of some activities and the hospital focus on the acute patients. This different organization may favor therapeutic continuity and the diagnosis of any new pathologies “.
“Greater interaction between General Practitioners and infectious disease specialists is essential – highlights the Hon. Mara Lapia – The health of the future resides in a more rooted local medicine, with in-depth training and able to intervene quickly with screening and diagnosis, which, if it arrives in time, for some diseases can be decisive not only to survive, but also to ensure a good level of quality of life. Therapies, treatments, follow-ups and controls can become solutions especially in fragile patients such as cancer patients, on whom the linkage-to-care for an infectious disease can be even more relevant “.