[The effective Communication in Vaccination Program as a Patient Safety tool: the Lombardy region experience]. / La comunicazione in campo vaccinale quale strumentodi implementazione della Patient safety e della partecipazione responsabile del Cittadino: l'esperienza della Direzione Generale Sanità della Regione Lombardia.

The communication is strategic in Public Health because it is at the heart of who we are as human beings. It is our way of exchanging information and it also ensures the effectiveness of empowerment strategies. In this semantic context, the effective communication/education/information can be a Patient Safety tool because can reduce the adverse events by failure of information or education. In the multicultural collectivity, the risk of miscommunication and unsafe care is very high. This paper describes the design of a multilingual information/education tools to reduce the information failure in vaccination and the related adverse events by information failure or deficiency of adherence in the paediatric vaccination.

Access to rehabilitation facilities in an unselected hospital population affected by acute stroke.

The aim of this study was to evaluate the selection criteria and characteristics of the patients who have access to rehabilitation facilities after having experienced an acute stroke. Between January 1993 and February 1994, 383 patients were recruited in 13 hospitals in Lombardy, and telephonically followed up four months after study entry. The data were collected by members of the Associazione Volontari Ospedalieri (Hospital Volunteers' Association). The 4-month mortality rate was 23%. The primary selection criterion for gaining access to rehabilitation facilities was the degree of disability; the secondary factor was age. Rehabilitation facilities were not available to very severely afflicted or self-sufficient patients, but were preferentially made available to young, partially-dependent patients. A rehabilitative intervention within the first month was made available to fewer than 50% of the patients for whom it was indicated. The absence of care for elderly patients and the delay in its availability for those who actually receive it underline the need for new organisational methods. The data presented here also show that voluntary associations can work as observers of the health service. A more complete study is required in order to understand the real dimensions of the problem and the clinical and social characteristics of the population involved.

[Access to rehabilitation resources for an unselected hospital population of patients with acute seizures]. / Accesso alle risorse riabilitative in una popolazione ospedaliera non selezionata di pazienti con ictus in fase acuta.

The study aimed at evaluating selection criteria and basic characteristics of acute stroke patients admitted to rehabilitation programs. From January 1993 to February 1994, 373 patients from 13 hospitals of the Lombardy region were admitted to the study. The 4 months telephone follow-up was performed by the AVO (Hospital Volunteers Association) volunteers. The 4 months fatality rate was 23%. The patients with a higher disability level were prescribed a rehabilitation program. Rehabilitation resources were not available for very severe or dependent patients being mostly the younger and partially dependent patients more often referred to the services. Only 50% of eligible patients received a rehabilitation intervention within 1 month from the index episode of stroke. The lack of caring resources and the long waiting times stress the need for a reorganization of the rehabilitation services. This study also shows that volunteers can play a role of stricter collaboration with doctors and are ready to collaborate in data collection. A larger and more detailed study is warranted in order to gain a better knowledge on the problem and on the clinical and social characteristics of the stroke victims.

Consequences of mental distress recognition in general practice in Italy: a follow-up study. Italian Cooperative Group on Mental Distress in General Practice.

Many reports have been recently published on the accuracy of mental distress detection by general practitioners. Recognition of 'caseness', irrespective of its accuracy, nevertheless determines the implementation of therapeutic interventions. This paper reports the results of a naturalistic study describing the consequences for the patients of being identified as 'cases' in the general practice (in terms of referral strategies at recruitment and outcome 3 months and 1 year later), in the context of care provision generated by the 1978 Italian psychiatric reform. Sixty-eight GPs recruited 878 'cases' according to implicit criteria. Overall 20% of the patients were referred the psychiatric setting; only half of these for psychiatric care. After 3 months and 1 year from recruitment respectively 12% and 23% of the subjects were no longer 'cases'. The factors contributing to predict the outcome at three months were age, symptom duration, comorbidity, presence of social context risk factors and prior psychiatric history (or presence of 'major' symptoms); after one year the predictors of caseness were caseness status at 3 months, and clinical severity, symptom duration and presence of somatization at recruitment. GPs remain the main care providers in the short- and long-term. The results of the study indicate the need for a reappraisal of the emphasis to be put on caseness recognition and on the development of standardized instruments for the identification of mental distress. Non-clinical variables concurring in the definition of caseness in general practice, and the factors influencing physicians' decision-making in the implementation of alternative intervention strategies should be further clarified by ad hoc studies.