What are the new processes and professional figures we need today to create a proximity-based social-healthcare service that looks after patients at all stages- from diagnosis to treatment?
By definition proximity is nearness in time and space. It is a simple definition but it can have many different meanings, especially in a context where in recent years the healthcare system focused mostly on enhancing its management of acute conditions at the expense of the daily need to provide proximity-based care to patients with chronic pathologies. Citizens diagnosed with a chronic condition require regular check-ups rather than pharmaceutical treatments that are not continuous and they expect to be inserted in an organised system that enables them to do this effectively and sustainably. How can there be proximity in the absence of the organisation and integration of services needed to guarantee continuity of care? Let’s reflect on what the real needs of patients with chronic conditions are and what professional figures the system should start to rely on. For example, looking at the local healthcare provision models of other countries, such as the French one, which is very efficient at providing home based services, it is clear that a versatile context like the current one requires a network of local services that relies on multiple professional figures: general practitioners (GPs), specialists, nurses and pharmacists. Citizens/patients should be at the core of this organised network, which should be able to meet their health needs and prevent any difficulties managing the condition that might also impact their relatives and caregivers. Treating the symptoms or the disease isn’t enough. It is necessary to also look after the socioeconomic impact of the disease in relation to the general public system- meaning the organisation of the country, thus constitutional rights such as the right to health and to work, which must always be guaranteed.
Let’s reflect on what the real needs of patients with chronic conditions are and what professional figures the system should start to rely on.
Where to restart?
From the notion that managing the health of citizens requires patients to be at the centre of the process. It’s also essential to study the demographical and epidemiological composition of the population in order to design the correct prevention and healthcare planning strategies. The principle of proximity should be present since the start, when citizens are healthy, and be part of the integrated journey that should follow the onset of a pathology. Another essential element is the clear definition of the responsibilities of each healthcare worker and the need for each of these professional figures to evolve towards an integration, which requires their remit to change as well, in order to achieve a more modern and innovative vision of public and integrative healthcare.
Proximity-based healthcare also means being able to communicate and dedicate time to patients to explain about their condition and how it can be treated, ensure they understand their duties around their own health and also the value of continuity of care, making them aware of the fact that health is important but comes at a cost for society and they are responsible for this as well. Based on this view patients should have an active role, feel involved and responsible for their actions. The average Italian is still attached to the idea of a healthcare service where all the services provided are free and as such they are taken for granted. Based on this logic it’s not easy to place the cost of services or treatments in an adequate manner because an innovative oncological treatment “would weigh” as much as treating hypercholesterolemia does. Interrupting the prescribed treatment and messing up or reducing the dosages isn’t viewed as harmful even though it actually does reduce the effectiveness of what’s been done until then both in terms of therapy and financial investment.
Patients should have an active role, feel involved and responsible for their actions.
What solutions should be developed “beyond drugs”?
Our mission as an organisation is centred on responding to the needs of patients and during recent years we focused specifically on awareness raising work around different ways to increase treatment adherence. Five years on from the National Plan on Chronic Conditions the matter of treatment adherence is still undervalued and struggles to take off in its multidimensionality. In the clinical context of cardiovascular conditions the average treatment adherence is still below 50%. An increase to 70% would avoid more than 82,000 heart attacks and strokes and would save the National Healthcare Service 330 million euros. Cardiovascular and oncological conditions can often be disabling for patients and the provision of “close” care requires tools and treatments that can respond effectively to their needs; for example, oral oncological treatments that can facilitate continuity of care and improve quality of life as they are administered at home. Over the last 15 years Servier has been investing in the development of adjunctive treatments, polypills to use in the cardiometabolic context and oral oncological treatments that, because they’re easier to take, favour the increase in treatment adherence and the important clinical, economic and social benefits that follow.
Our challenge around improving treatment adherence was to look for solutions “beyond drugs” and invest substantially on widespread communication that could reach all the parties involved: healthcare operators, patients and institutions. Doctors have an important role to play to ensure their patients understand the importance of treatment adherence or to choose together what treatment strategies to adopt. Pharmacists too play an important role in the treatment and follow-up of patients with chronic conditions and this function was emphasised greatly with the implementation of pharmacies that provide healthcare services. However, as already mentioned, patients’ engagement is as essential. In order to help them understand what to do and why we developed projects and awareness raising campaigns designed for this specific population target, the over 65s, which in Italy are over 8 millions and suffer from at least one chronic condition.
We believe our role has been instrumental to facilitate dialogue and emphasise the importance of this matter. Thanks to all the strategies implemented so far all the parties involved are now showing signs that they are more aware and willing to take action around this issue. We will play an even more important role in the implementation of the National Recovery and Resilience Plan and in terms of investments in order to develop a proximity-based care model that looks after patients with chronic conditions.
Edited by Laura Tonon