The agreement identifies the ways in which continuity of care doctors will operate within the new network of CAUs, territorial structures for low-complexity emergencies. Donini: “Fundamental step towards a more effective and sustainable system, to guarantee the best possible assistance for patients and the quality of work of professionals”
06 JUN –
A fundamental step forward for the emergency reform desired by the Emilia-Romagna Region, one of the first in Italy to rethink the system to make it more effective, sustainable and at the same time guarantee the health of citizens and the quality of work of healthcare professionals who work there.
In fact, an agreement was signed between the Region and the trade union organization of general practitioners Fimmg according to which the “medical guards”, now Doctors of Continuity of Care, will work as a team in the Medical Assistance Centers for Emergencies on a territorial basis, which the Region is creating. They will act, explains a note, for what concerns the management of urgent health needs of citizens with low complexity, usually identifiable as white and green codes. The latter today represent about 70% of the services that pour into the Emergency Department.
The trade union organizations in question are headed by both family doctors (technically defined as “single role of primary care with a cycle of choice”) and former medical guards (“single role of primary care with hourly activity”) but above all the latter will be responsible for to play a decisive role in the new model that is taking shape.
The agreement – illustrated this morning at a press conference in the Region – takes up and adopts the fundamental principles identified by the current national collective agreement for general medicine of 2022 which, in the light of demographic and technological changes, underlines how it is necessary to take charge of the citizen and a greater integration of general practitioners in the territorial networks of services. This integration, according to the national contract, avoids access to the emergency room for non-urgent services.
“A very important agreement reached with the unions of general practitioners, because their contribution is essential to make a system that is no longer sustainable even more efficient and capable of responding to the new needs of care and assistance – explains the commissioner health policies, Raffaele Donini -. This is a fundamental step: it will certainly take time and gradually to implement this reform, but I am confident that we will soon arrive at a more effective and sustainable system, guaranteeing the health of citizens and the quality of the work of professionals”.
The agreement “Involvement of doctors in the sole role of primary care in local structures for low-complexity emergencies”, starts from two premises: the involvement of doctors in the unique role of primary care in the organization and planning of territorial activities at district, company and regional level is a consolidated experience which characterizes Emilia-Romagna as a cutting-edge region; the doctors confirmed their willingness to actively participate in the emergency-urgency reorganization process, both guaranteeing support in the planning phase and making themselves available, where possible, for the activation of local structures for low-complexity emergencies.
The key points of the agreementThe agreement identifies two distinct channels: low-complexity emergencies are basically the responsibility of the former medical guards and, subordinately and voluntarily, family doctors, leaving the 118, Emergency Department and DEA (the Departments of Emergency and Acceptance at hospitals) emergencies of medium or high complexity.
The first case includes situations in which the patient can walk independently, experiences mild or moderate pain, presents a clinical picture whose diagnosis can be resolved on site perhaps after an echocardiogram, an ultrasound, x-rays where foreseen or basic biochemical tests. It may also be the case for non-serious situations involving gastrointestinal symptoms, low-onset fever, low back pain, non-traumatic joint pain, minor burns, anxious states, dizziness, but also medications or removal of stitches for tourists or off-site students temporarily without of attending physician.
After the visit, the patient can be referred to his own doctor, or vice versa be sent to the Emergency Department if clinical emergency situations arise. In fact, the CAU doctors will be connected by telephone with the 118 operations center and will have the times and telephone numbers of the attending doctors available. Those who report, for example, chest pain, severe abdominal pain, an intense and unusual headache, an acute neurological disorder or difficulty breathing will be more easily referred to the emergency room.
I CAU The physical places where low-complexity emergencies will be managed will be the CAUs, structures to be built throughout the territory – at least one per district – to ensure coverage for the entire regional population, with particular attention to non-urban or less populated areas: established preferably in community homes, but also in suitable premises made available by health authorities or municipalities, or obtained from the conversion of emergency rooms and first aid points or activated in nearby territorial hospitals without DEA. Even a structured aggregative form of general medicine, organized and suitable, can be the site of such care settings.
The CAUs will be active 7 days a week with the aim of covering 24 hours, in relation to the expected volume of activity and the needs of the territory.
The structures will be equipped with a waiting room, an examination room, a brief post-examination observation room, services, an IT system, adequate technical-sanitary equipment for the main diagnostic tests and will have to see at least one doctor and one nurse at work. Such staff cannot carry out home care activities at the same time. The setting up of the technological equipment will be the responsibility of the Region and will go hand in hand with the training activities necessary for the doctors of the facility.
Doctors on duty, in recognition of the required commitment, will be assigned an additional hourly incentive of 18.35 euros which is added to the 23.65 euros provided for by the national contract.
Training
Ample space of the agreement is in fact reserved for the training objectives for the doctors involved, which obviously cover a very varied picture ranging from pediatrics to dermatology, from cardiovascular to respiratory topics, from neurology to ophthalmology without neglecting cases of lacerations or problems to the musculoskeletal system. All of this, of course, within the overall framework of low complexity: the emergency room specialist will continue to be necessary for the most serious cases.
06 June 2023
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