Versions
- 2024-08-02 (2)
- 2024-08-02 (1)
Keywords
regional models
community hospital
community house
Abstract
After years of cost-containment policies, the Italian National Health Service (NHS) has now the chance to reshape and improve, especially thanks to the National Recovery and Resilience Plan (NRRP).
This plan serves as a catalyst for change, channelling substantial funds to reinforce proximity networks, facilities, and telemedicine for territorial healthcare. Mission 6, specifically dedicated to health, aims to integrate primary healthcare, hospital, and specialty care networks, emphasizing the importance of a robust primary healthcare system.
In alignment with NRRP objectives, the Ligurian model introduces innovative structures, including Community Houses (CdCs), Community Hospitals (OdCs), and Territorial Operation Centres (COTs). These components are interconnected, forming a dynamic network designed to enhance healthcare accessibility, prevent inappropriate hospital admissions, and facilitate efficient patient transitions.
The critical roles of Community Houses as hubs for proximity medicine, COTs as organizational hubs ensuring care continuity, and Community Hospitals for intermediate care underscore the comprehensive approach to health services. The model prioritizes multidisciplinary collaboration, community engagement, and the integration of socio-healthcare services.
Despite substantial NRRP funding for infrastructure, challenges related to staffing and human resources persist. The social and epidemiological context raises pertinent questions about the economic feasibility of the reform, potential workforce shortages, and the imperative for updated regulatory frameworks. The strategic reallocation of personnel from acute hospitals to new facilities is paramount, necessitating meticulous workforce planning, role definitions, and training.
In conclusion, the Ligurian model emerges as a proactive response to the structural vulnerabilities laid bare by the pandemic, aligning with international trends in emphasizing primary care, prevention, and community-based services.
References
Mauro M, Giancotti M. The 2022 primary care reform in Italy: Improving continuity and reducing regional disparities? Health Policy. Settembre 2023, p. 135:104862. doi: 10.1016/j.healthpol.2023.104862.
Filippini T, Vinceti SR. Italian National Recovery and Resilience Plan: a Healthcare Renaissance after the COVID-19 crisis? Acta Biomed. 17 Novembre 2021, p. 92[S6):e2021463. doi: 10.23750/abm.v92iS6.12339.
WHO. Primary health care. Available at https://www.who.int/health-topics/primary-health-care#tab=tab_1. Accessed on 8 December 2023
Rifkin SB. Alma Ata after 40 years: Primary Health Care and Health for All-from consensus to complexity. BMJ Glob Health. 2018;3(Suppl 3):e001188. doi: 10.1136/bmjgh-2018-001188.
European, Commission. National Recovery and Resilience Plan. 2021. http://www.politicheeuropee.gov.it/media/5651/pnrr-definitivo.pdf. Accessed on 8 December 2023
Milani C, Naldini G, Baggiani L, Nerattini M, Bonaccorsi G. How to promote changes in primary care? The Florentine experience of the House of Community. Front Public Health. 2023 Sep 5;11:1216814. doi: 10.3389/fpubh.2023.1216814.
Gola M, Brambilla A, Barach P, Signorelli C, Capolongo S. Educational Challenges in Healthcare Design: Training Multidisciplinary Professionals for Future Hospitals and Healthcare. Ann Ig. 2020 Sep-Oct;32(5):549-566. doi: 10.7416/ai.2020.2375.
Odone A, Saccani E, Chiesa V, Brambilla A, Brianti E, Fabi M, Curcetti C, Donatini A, Balestrino A, Lombardi M, Rossi G, Saccenti E, Signorelli C. The implementation of a Community Health Centre-based primary care model in Italy. The experience of the Case della Salute in the Emilia-Romagna Region. Ann Ist Super Sanita. 2016;52(1):70-7. doi: 10.4415/ANN_16_01_13.
Ugolini C, Leucci AC, Nobilio L, Bertè G. Reorganizing territorial healthcare to avoid inappropriate ED visits: does the spread of Community Health Centres make Walk-in-Clinics redundant? BMC Health Serv Res. 2020 Aug 27;20(1):807. doi: 10.1186/s12913-020-05648-x.
Buffoli M, Gola M, Rostagno M, Capolongo S, Nachiero D. Making hospitals healthier: how to improve sustainability in healthcare facilities. Ann Ig. 2014 Sep-Oct;26(5):418-25. doi: 10.7416/ai.2014.2001.
Pianori D, Avaldi VM, Rosa S, Lenzi J, Ialonardi M, Pieri G, Rossi A, Fantini MP. How do Community Hospitals respond to the healthcare needs of elderly patients? A population-based observational study in the Emilia-Romagna Region. Ann Ig. 2018 Jul-Aug;30(4):317-329.
Ministero della salute. Servizio Sanitario: i LEA . available at https://www.salute.gov.it/portale/lea/dettaglioContenutiLea.jsp?lingua=italiano&id=4773&area=Lea&menu=vuoto) Accessed on 8 December 2023
AGENAS. Documento di indirizzo per il metaprogetto dell'Ospedale di Comunità. Available at https://www.agenas.gov.it/comunicazione/primo-piano/2160-documento-di-indirizzo-per-il-metaprogetto-dell-ospedale-di-comunit%C3%A0. Accessed on 8 December 2023
Giulio de Belvis A, Meregaglia M, Morsella A, Adduci A, Perilli A, Cascini F, Solipaca A, Fattore G, Ricciardi W, Maresso A, Scarpetti G. Italy: Health System Review. Health Syst Transit. 2022 Dec;24(4):1-236..
Capolongo S, Brambilla A, Girardi A, Signorelli C. Validation Checklist for Massive Vaccination Centers. Ann Ig. 2021 Sep-Oct;33(5):513-517. doi: 10.7416/ai.2021.2460.
Roberts E, Mays N. Can primary care and community-based models of emergency care substitute for the hospital accident and emergency (A & E) department? Health Policy. 1998 Jun;44(3):191-214. doi: 10.1016/s0168-8510(98)00021-9..
Pinchbeck EW. Convenient primary care and emergency hospital utilisation. J Health Econ. 2019 Dec;68:102242. doi: 10.1016/j.jhealeco.2019.102242..
Roth L, Le Saux C, Gilles I, Peytremann-Bridevaux I. Factors Associated With Intent to Leave the Profession for the Allied Health Workforce: A Rapid Review. Med Care Res Rev. 2023 Oct 21:10775587231204105. doi: 10.1177/10775587231204105.
de la Torre-Díez I, López-Coronado M, Vaca C, Aguado JS, de Castro C. Cost-utility and cost-effectiveness studies of telemedicine, electronic, and mobile health systems in the literature: a systematic review. Telemed J E Health. 2015 Feb;21(2):81-5. doi: 10.1089/tmj.2014.0053.
Donald M, Jackson CL, Byrnes J, Vaikuntam BP, Russell AW, Hollingworth SA. Community-based integrated care versus hospital outpatient care for managing patients with complex type 2 diabetes: costing analysis. Aust Health Rev. 2021 Feb;45(1):42-50. doi: 10.1071/AH19226.
De Marchi F, Contaldi E, Magistrelli L, Cantello R, Comi C, Mazzini L. Telehealth in Neurodegenerative Diseases: Opportunities and Challenges for Patients and Physicians. Brain Sci. 2021 Feb 13;11(2):237. doi: 10.3390/brainsci11020237.