Transcript PCC in Italy SENESE

Counter-referral to
patient and/or GP
GP role within the referral system
GPs main feautures
•
GPs and paediatricians are self-employed professionals working with the
Italian NHS upon a National contract plus a regional and local integrative
agreements;
•
GPs have to guarantee: medical consultations, either at the physician’s
office or at the patient’s home, residential nursing homes and emergency
cases for their patients;
•
prescribing medications, integrated care, diagnostic tests and
laboratoryanalyses;
•
referrals for hospitalization, including day treatments/elective surgery;
•
services that require a health professional to administer care (e.g. sutures,
injections, intravenous injections);
•
flu vaccinations during vaccination campaigns aimed at targeted population
groups at risk.
Main issues
• Need for GPs to go beyond their traditional gate-keeper role for
hospital and specialist services to take on a greater role in
coordinating strategies to deal with chronic and degenerative diseases
(Chronic Care Mode);
• managing the growing complexity of diagnostic and ambulatory
(outpatient) services (lack of integration with ambulatory
specialists, no standardized guidelines nor outcomes monitoring
of GPs activity);
• playing a greater role in health promotion strategies.
 No formal PHC equipes
 No university degree required in family/community medicine to
practice;
 No explicit definition of PHC services in the national essential levels of
care (LEAs) (Corsalini e Fattore, Mecosan 2012; 82: 61-75).
Policy efforts
• Encouraging the institution of Primary health
centres (Case della salute) to overcome solopractice;
• Improving ICT systems to facilitate outpatientinpatient information sharing;
• Definition of clinical pathways, GPs and
specialists’ role witching the pathways and
patients referrals.
 Important regional differences
Pending policy questions in
Primary care
• What payment arrangements for the new
Primary health centres (Case della
salute)?
• Payment schemes: what mix of pro-capita
and clinical pathways outputs/outcomes?
• How to shift part of GPs remuneration
towards équipe activities?