scholarly journals Public health and multiple sclerosis in Italy

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D Bezzini ◽  
M A Battaglia ◽  
M Ponzio ◽  
T Manacorda ◽  
P Zaratin ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Health System ◽  
National Health ◽  
Care Pathway ◽  
Clinical Care ◽  
National Health System ◽  
Interdisciplinary Management ◽  
Care Pathways ◽  
Health And Social Care ◽  
Diagnosis Therapy

Abstract Background Multiple Sclerosis (MS) is a complex and progressive disease of the central nervous system. In Italy, prevalence of MS ranges from 198 (continental Regions) to 370 (Sardinia) per 100,000. Despite a National Health System, differences among Regions cause inequalities in access to and quality of care, also involving chronic diseases and disabilities, including MS. Methods Interviews and focus groups involving persons with MS, caregivers, institutions, patients association and other stakeholders were conducted in 2019, to evaluate MS policy landscape, existing services, guidelines and care pathways regarding diagnosis, therapy, follow up, strenghts and weaknesses. Results 600 MS specialized neurologists and 350 MS nurses operate in 240 MS Centers located in hospital neurology departments providing clinical care, disease modifying drugs (DMDs), interdisciplinary care. 13 Regions on 20 approved a PDTA (Diagnosis, Therapy, Care Pathway), other are due by 2020. A reference national PDTA has been already discussed by Regional Health Authorities Conference and Ministry of Health. Regional multistakeholder observatories will be organized. A national MS registry started in 2017, at present involving over 140 Centers and including data of 50% (60.000 patients) of estimated prevalence. Discussion MS specialized centers are recognized as the key component of MS care in Italy and the main refererral for 80% of patients, also taking in account that over 60% of patients receive a DMD. Access to rehabilitation is lacking and hospital, community and primary care linkage is needed, also considering transition from early stages to severe disability. Access to psycological support is variable and cost containment strategies restrict drug access and symptomatic care in some areas along with lacking of interdisciplinary management. It is mandatory to integrate health and social care pathways accordingly with the National Plan for Chronicity in which MS has to be included. Key messages MS specialized centers are the backbone care network in Italy. Integrated care pathways (PDTA) stated as National Health System rules define the right for the patients to receive the proper care.

scholarly journals Proposal of a clinical care pathway for quality and safe management of headache patients: a consensus study report

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e037190
Author(s):  
Julio Pascual ◽  
Patricia Pozo-Rosich ◽  
Irene Carrillo ◽  
Sandra Rodríguez-Justo ◽  
Dolores Jiménez-Hernández ◽  
...  
Keyword(s):  
Care Pathway ◽  
Clinical Care ◽  
National Health System ◽  
Diagnostic Errors ◽  
Healthcare Management ◽  
Care Process ◽  
Quality And Safety ◽  
Clinical Safety ◽  
Safety Standards ◽  
Headache Patients

BackgroundHeadache is one of the most prevalent and disabling conditions. Its optimal management requires a coordinated and comprehensive response by health systems, but there is still a wide variability that compromises the quality and safety of the care process.PurposeTo establish the basis for designing a care pathway for headache patients through identifying key subpathways in the care process and setting out quality and clinical safety standards that contribute to providing comprehensive, adequate and safe healthcare.MethodA qualitative research study based on the consensus conference technique. Eleven professionals from the Spanish National Health System participated, seven of them with clinical experience in headache and four specialists in healthcare management and quality. First, identification of the key subpathways in the care process for headache, barriers/limitations for optimal quality of care, and quality and safety standards applied in each subpathway. Second, two consecutive consensus rounds were carried out to assess the content of the subpathway level descriptors, until the expert agreement was reached. Third, findings were assessed by 17 external healthcare professionals to determine their understanding, adequacy and usefulness.ResultsSeven key subpathways were identified: (1) primary care, (2) emergency department, (3) neurology department, (4) specialised headache unit, (5) hospitalisation, (6) outpatients and (7) governance and management. Sixty-seventh barriers were identified, the most frequent being related to diagnostic errors (36,1%), resource deficiency (25%), treatment errors (19,4%), lack of health literacy (13,9%) and inadequate communications with care transitions (5,6%). Fifty-nine quality and 31 safety standards were defined. They were related to evaluation (23.3%), patient safety (21.1%), comprehensive care (12.2%), treatment (12.2%), clinical practice guidelines (7.8%), counselling (6.7%), training (4.4%) and patient satisfaction (3.3%).ConclusionsThis proposal incorporates a set of indicators and standards, which can be used to define a pathway for headache patients and determine the levels of quality.

Experience in applying the effectiveness audit methodology in order to save budget funds for the purchase of medicines in the UK

2020 ◽  
pp. 82-87
Author(s):  
S. S. Budarin ◽  
N. V. Yurgel
Keyword(s):  
United Kingdom ◽  
Health System ◽  
National Health ◽  
Sharp Increase ◽  
National Health System ◽  
Pharmaceutical Market ◽  
National Audit ◽  
Drug Pricing ◽  
The United Kingdom ◽  
The Uk

The article examines the experience of the national audit office of the United Kingdom in conducting an audit of the effectiveness of budget funds aimed at providing medicines to English citizens. The reasons for the sharp increase in budget expenditures for providing the population with reproduced medicines in 2017—2018 are described in detail.The article analyzes the shortcomings of the system of regulation of drug pricing procedures and the resulting risks to the budget of the national health system in United Kingdom.It is concluded that the effectiveness audit has allowed us to identify not only the reasons for significant overspending of the NHS budget to provide the population with medicines, but also to assess the actions of organizations authorized by the UK Government to address issues of regulation of the pharmaceutical market.

I limiti del tempo in un tempo di limiti

2009 ◽  
pp. 55-62
Author(s):  
Fabrizio Rizzi
Keyword(s):  
Health System ◽  
Key Words ◽  
Community Service ◽  
National Health ◽  
National Health System ◽  
Short Term ◽  
Intellectual Honesty ◽  
Life Itself ◽  
Environmental Limits

- This article recounts the doubts and fears of an experienced analyst who is now an apprentice acrobat. He is forced to keep himself tiredly balanced between psychological and physical limits imposed by age, restrictions introduced by the National Health System and categories of patients who have precedence over others. He cannot receive all of the patients who ask for him and even those who he does receive will have to be discharged in the short term. Explaining to them, with intellectual honesty, that the community service has rules that limit his wishes as well. What can this be if not acrobatics? In the end it means combining the contradictory but perhaps also the most real aspects of life itself. [KEY WORDS: desires, personal and environmental limits, truth of the therapist]

A view from abroad: a New Zealand perspective on the English NHS health reforms

2016 ◽  
Author(s):  
Robin Gauld
Keyword(s):  
Health Policy ◽  
New Zealand ◽  
Health System ◽  
Access To Care ◽  
Healthcare System ◽  
National Health ◽  
Universal Access ◽  
National Health System ◽  
High Income ◽  
Coalition Government

The English NHS is of significance among health policy observers around the globe for various reasons. The NHS is particularly noteworthy for the fact that, for many, it represents the high-income world’s best attempt to have built and maintained a ‘national’ health system with a focus on universal access to care that is free at point of service. The NHS has been in transition for several years. Many commentators have highlighted the role and influence of US market ideals in this transition, with various UK governments clearly pushing this agenda. However, is often useful to look to countries more closely comparable to England, such as New Zealand, for comparison with a view to improvement. This chapter takes such an approach in looking at the NHS from abroad. It draws upon the case of NZ which, in many ways, is very similar to England when it comes to health policy and the healthcare system. In doing so, it aims to provide a critique of the NHS reforms and demonstrate that there are alternatives to the policies and structures being pursued for the English NHS by the Coalition government.

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