HOW are the onco-haematological day hospitals in Italy? To photograph their “state of health” are the results of the survey promoted by Cittadinanzattiva, with the unconditional support of Roche, which monitored 44 realities of the Peninsula, highlighting strengths and weaknesses. Despite a rapid start of therapies, there is still work to be done on the speed of the routes for administering individual therapies within the structures: too slow, with waits that can reach up to 8 hours. Even the use of digital solutions and computerization for patient management remain limited tools, and the link between hospital and territory remains underdeveloped. From this work the Civic Recommendations are born to design efficient paths and improve the quality of life of the 3.6 million Italians living with an oncological pathology.
There is still work to be done
From what emerged from the monitoring, a little organization is lacking: 13.6% of onco-haematological day hospitals convene patients at the same time without staggering them according to the type of therapy; over 22% do not separate the paths between those who have to carry out checks or short therapies and those who have to undergo infusion therapy; more than 40% do not monitor the times between the various phases in order to improve the treatment path and over 20% do not use software to manage the patient’s path. Furthermore, the digital solutions that make it possible to bring the hospital closer to the territory are not adequately exploited: 20% of the structures monitored do not issue the electronic prescription, 34% have not activated and do not feed the health file, while as many as 54 % has no computerized medical records. Finally, half of the structures have not activated telemedicine services and more than 30% do not provide for the case manager, as a link between the hospital and the territory.
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Solutions from the pandemic
The pandemic has led to the need to reduce the movement of people, especially the most fragile, and has forced the implementation of procedures and services to contain the number of patients in day hospitals. There have been some experiments, but with many disparities between one structure and another. Only 18% of day hospitals activated the delivery of medicines at home, for example, while 31% identified places of care closest to the patient (18.2% directly at home). In 35% of the structures, when possible, short-term or oral therapies were chosen that could be managed more easily at home or that required less time to spend in day hospital.
“With this monitoring we wanted to photograph the organization of day hospitals in this emergency phase in order to seize, in addition to the difficulties encountered, also the opportunities that arose from the pandemic, analyzing innovative organizational structures and strategies towards which the models of care for cancer patients will be able to tend to the future ”, commented Valeria Fava, head of health policy coordination at Cittadinanzattiva.
Civic recommendations
In light of what the survey highlighted, it is not difficult to identify the areas that still need intervention and imagine how to develop treatments for onco-haematological patients: the trials in the Covid era have paved the way and new opportunities will come from the applications of the Pnrr.
From the work of Cittadinanzattiva, therefore, some recommendations have emerged for continuing to implement models that are increasingly suited to the needs of onco-haematological patients. They are proposed to design quality pathways for cancer patients, born from sharing with institutions, health professionals, scientific societies and patient associations. “They represent a road map of commitments and concrete actions to improve the treatment path and the quality of life of the cancer patient and redesign the model of assistance in the area”, clarified Fava. There is talk, for example, of establishing regional oncological networks everywhere, of developing specific Pdta for pathology, of promoting assistance and treatment methods that are closer to patients (as in future community homes and hospitals and, where possible, at the patient’s home).
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Just as experienced by some pandemic centers, drug delivery services to the patient’s home should be implemented for oral therapies, which are usually distributed directly. Another wish is the simplification of the treatment path, guaranteeing the booking of visits and examinations necessary for monitoring the pathology and for follow-up at the end of the therapeutic cycle.
Furthermore, the paths in day hospitals should be optimized, allowing the execution of samples even in places other than the structure, staggering appointments based on the type of therapy (short or long), separating the paths for checks and oral therapies from those for the administrations, adopting, where possible, ad hoc rooms for short therapies.
The figure of the “case manager” should be identified in all structures and become the point of reference for the patient / family member / caregiver and for all the professionals involved in the path. The document also does not neglect the dialogue between patient and hospital pharmacist, suggesting the implementation of the use of the tele-pharmacy.
It will be very important to adapt digital infrastructures and promote the e-health solutions available today to ensure the best connection between local and hospital care, to promote training courses for doctors and specialists, but also for patients and their caregivers, with the support also of civic organizations and patient associations.