A new model of continuity of care is active in Ats della Montagna thanks to the “Unic.A” platform which is based in Morbegno and is active every day.
It is the new territorial medical center, activated on an experimental basis, the first ever in Lombardy, last March 4, and today it has permanently become part of the active health services in the territory of Ats della Montagna. The initiative, born from the collaboration between Areu, Asst Valtellina and Alto Lario and Ats della Montagna, represents the full integration, in line with national and regional indications, of 2 parallel projects designed by each company to address the respective specific criticalities. On the one hand, AREU needs to reduce the improper use of Emergency/Urgency services, the overcrowding of the Emergency Department and to facilitate the transition towards home management of the frail patient.
On the other hand, Ats della Montagna has for some time highlighted the constant shortage of doctors (both general practitioners and continuity of care doctors), has difficulty covering the continuity of care stations in the area as well as guaranteeing the satisfaction of the needs of the patients with the available resources (as is known, the territory of Ats della Montagna, by extension and conformation, imposes long journey times to reach the health facilities).
AREU’s response to the problem was to provide for the development of a platform through which to guarantee healthcare assistance thanks to televisits, teleconsultations and the use of dematerialized prescriptions. Using the Ats della Montagna platform, it has therefore reprogrammed the Continuity of Care service, in relation to the orographic needs of its territory, setting up a central – Unic.A. – supervised by medical personnel.
How does it work
Therefore, by calling the single number 116117, Unic.A receives health requests that can be managed via television and dematerialized prescriptions. This makes it possible to respond effectively and efficiently to the needs of citizens by limiting outpatient access and home visits to cases that really need it. In summary, the doctors present via the telemedicine platform and connected to the SISS perform the following activities:
- telephone consultation, pharmaceutical and dematerialized outpatient prescription
- activation of the outpatient visit with direct access of the patient to the identified territorial station
- activation of home visits through the Doctor on call
- sending to the Emergency Department by activating 112
The first data
Since the service was activated on 4 March, 1,481 calls have been handled. On public holidays there are 2 doctors from 8:00 to 24:00 and one doctor from 24:00 to 8:00. On weekdays, on the other hand, the service provides for the presence of two doctors from 19:00 to 24:00 and one doctor from 24:00 to 8:00.
The data available to date show that on holidays, in the 8:00/24:00 time slot, an average of 10 calls were handled per hour, while in the 24:00/8:00 slot 4 calls per hour. On weekdays, from 19:00 to 24:00, an average of 3 calls/hour are handled, while in the night range, from midnight to 8:00, the average of calls is 1 per hour.
12% of the requests are classified as “fever”, 11% as “vomiting”, the remaining percentage as Covid, allergy, headache, hypertension, anxiety, abdominal pain and more.
- 100% of the calls were followed by the sending of the report.
- 26% were sent a dematerialized prescription.
- 3.5% of the calls received a specialist outpatient diagnostic prescription (always dematerialized)
- 7% of the calls were provided with a telemedicine service.
Compared to the type and origin of the users, it emerged that over 40% of the patients are aged between 15 and 45, 18% are over 65. 9.3% of the interventions, on the other hand, concerned minors (0/5 years). The Municipalities with the greatest frequency of access are those with a high tourist vocation.
“The conclusions – comments the health director of Ats della Montagna Maria Elena Pirola – can only be positive. The activation of the new organizational model, based on the Unified Medical Center (Unic.A), making use of the telemedicine technological platform made available by AREU, has allowed the optimization of the Continuity of Care service, guaranteeing, on the total number of calls made, in 70% of cases a televisit, with relative transmission of the report and the prescription, thus ensuring the citizen the answer directly at home, avoiding travel. The approval expressed by citizens was also high, especially by caregivers of the elderly. Only 20% of intervention requests were transferred to outpatient stations, with a significant decrease in direct accesses. In 2% of cases, a home service was necessary (mainly death confirmations). The remaining 8% of cases were managed by 118. It is also comforting to note the proactive attitude of the continuity of care doctors involved in the project, who got involved in the problem solving processes, showing interest and satisfaction”.
“In the future – comments the general manager Raffaello Stradoni – we intend to apply the model in Community Homes with full integration of primary care with the Emergency/Urgency service and reference hospitals, also by developing teleconsultation activities involving specialist doctors such as the pediatrician or cardiologist. We are also evaluating the hypothesis of developing home treatment for the frail by increasing and strengthening home visits, with diagnostic and telemedicine tools”.
With the activation of the Unic.A control unit, nothing changes compared to the past. All access requests pass only and exclusively through the single number 116117.