Healthcare that looks to the future, through new technologies and integrated home care. These are among the priorities indicated by Prime Minister Mario Draghi in his keynote speech. Giuseppe Conte’s successor focuses on a more rooted and better developed territorial medicine, citing telemedicine as an ally. In Forlì, for example, the covid-19 pandemic has accelerated several projects of medical and IT techniques that allow the treatment of a patient at a distance or more generally to provide health services at a distance.
To cite some examples rehabilitation for breast operated women, a service that in addition to its therapeutic value and which serves to make women feel less alone in this period of isolation, while the Youth Counseling Center regularly carries out personal video interviews with young adolescents via video call, via Whatsapp or Skype. Another noteworthy example is that of the Neurology Operating Unit, which uses telephone and video contacts to assess the status of neurological patients, just as the Forlì Mental Health Center also makes remote online visits to patients.
And in the fight against covid, thanks to the Rotary donation, the Usca (special care continuity units) have a device for connecting from the home to the application for filling out reports via hotspot from the doctor’s smartphone and the creation of a Virtual Private Network. Aspects that ForlìToday had to delve into with Mattia Altini, medical director of the Ausl Romagna.
Altini, in the course of his speech, Prime Minister Draghi underlined how it is necessary to open an all-out discussion on the reform of our health care and that it is necessary to “strengthen and redesign local health care”. What do you think?
In the past we had already analyzed the need to strengthen local activities and the evidence has long been established in this sense. However, we have not transformed the reflections into actions, aimed at relocating the assistance activity in the care settings. We therefore risked conceiving the hospital as the only answer to the welfare needs of citizens, which was not designed in this sense. After the pandemic we had to rethink all ways of relating to citizens, with the aim of reducing the pressure on hospitals and also, obviously, the risk of contagion. At this point it becomes necessary to organize a very strong territorial medicine to respond to the needs of citizens in the place where they live. It is equally true, however, that the founding values of law 833 on the health service always remain current and at the center of our actions.
Community homes, community hospitals, counseling centers, mental health centers and proximity centers against health poverty are the priorities indicated by the premier. A real revolution, don’t you think?
These are ways of taking care of proximity attentive to the needs of patients in the place where they live. It is clear from the international literature that income still represents a barrier to access to the health service, even in a universalistic system like ours. Income must therefore be redistributed to ensure health, as well as work. The hospital “without walls” and the home as a place for continuity of care represent the future of medicine. This process has been accelerated by the pandemic event, even if it is evident that the care must be close to the patient’s home and must respond to needs in a holistic way. Finally, it is evident that a strong technological investment is essential to create this proximity medicine system.
Furthermore, for Draghi, the “home” of patients must become the “main place of care”. A revolution possible thanks to “telemedicine” and “integrated home care”. How is the Ausl Romagna moving on this aspect? What projects are underway and which are in the pipeline?
Ausl Romagna has a project, which I believe has few other examples in Italy, of a “Digital twin”. The goal is to make all health information interoperable in order to put citizens’ needs at the center and increase their knowledge and ability to interact with the system. A digital twin that includes medical records, a patient’s laboratory results, in combination with a clinical path model, helps ensure optimal decision making regarding that particular patient’s treatment, helping healthcare professionals to best outline the Diagnostic Therapeutic Assistance Pathways. For chronic diseases, lifestyle, place of residence and how you take care of yourself make a huge difference in the possible development of complications or other related conditions. In this scenario, the digital twin should include physiological and behavioral data in order to help the patient and physician effectively manage the evolution of the disease, for the benefit of patients and the entire healthcare system.
How does it develop?
One of the most typical activities of this project are the “prems”, the continuous observers of the patient experience (“prems”, Patient Reported Experience Measures) and of the outcomes (“proms”, Patient Reported Outcome Measures). Through these methods the citizen, just to give an example, can communicate with the health system directly from his smartphone, interacting with specialists without going to the hospital. The acronym “proms” means the outcome measures that are reported directly by the patient, for the evaluation of his state of health, thus clarifying his state of health with the use of the mobile phone. The role that patients can play in improving the quality of health care is now recognized. With patients, as key stakeholders of the healthcare sector, there is a growing interest in working in partnership in order to jointly evaluate healthcare services and, therefore, create added value.
However, telemedicine must also have a solid foundation, that is, a basic knowledge of computer science, and not all elderly people are familiar with computers or smartphones, don’t you think?
The use of the smartphone is also usable by the elderly population, who can still be assisted by caregivers or by operators of voluntary associations.
The opportunity to reform health care “across the board” can come from the Recovery plan …
The “digital twin” mentioned above is a project that Ausl Romagna is preparing precisely to be ready, even with structural reforms, to use the Recovery Plan in the fastest and most effective way for citizens.
We are one year from the start of the covid-19 pandemic. What do you remember of those days?
At the time I was medical director of the Irst of Meldola. All efforts were made to ensure that the Research and Cancer Institute remained “covid free”, in light of the particular pathology of the patients treated.
On the front right away. Where do doctors and nurses find all this energy?
Being a doctor and a nurse is a calling. Energy comes from the desire to make a contribution to the common good.
What is your message to those who are pawing to return to total freedom?
The desire for normality and to return to economic security must be combined, however, with rigorous behaviors that allow us to be able to return to this longed-for normal life. The vaccination campaign, for this purpose, must be as widespread as possible. Furthermore, the approach of spring first and then summer, thus frequenting more outdoor places, will help to contain the spread of infections.
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