ABSTRACT
The new european declaration "Core values and principles of general practice and family medicine" (Wonca Europe 2022) has been recently issued: which contributions can it provide to the discussion on the future of primary health medicine? And what challenges and changes would it impose in its application to the contexts of medical training, care services and clinical research in Italy? We analyse here the seven principles and values of the new declaration: 1) person-centred care; 2) continuity of care; 3) cooperation in care; 4) community-oriented care; 5) equity in care; 6) science-oriented care; 7) professionalism in care; and through them we reflect on the announced reforms of primary health care (Phc) policy. Indeed, these provide an important basis for a critical discussion regarding the reform of the primary care model, the evolution of the medical training pathway (pre- and post-graduate and therefore towards an adjustment of the specialty pathway of future general practitioners) and research Phc. Considering that the Phc health policies are experiencing a condition of permanent and apparently uncontrollable change, it is well to ask ourselves how and if these values-principles, which are considered fundamental at an international level, will be able to come to life in order to build a new therapeutic trust, specific to general practice and family medicine, both in the professional and disciplinary sphere.
Subject(s)
General Practice , General Practitioners , Humans , Italy , Europe , Health PolicyABSTRACT
In June 2015, the working group "Primary Health Care" of the Italian Society of Hygiene Representatives of Hygiene and Preventive Medicine Residents, performed an online questionnaire survey among residents of this specialty in Italy, to analyze their training needs regarding primary health care. In total, 730 residents in 32 schools were invited to participate by email, of whom 40.7% (297/730) completed the questionnaire. Most of the respondents were female (66.7%) and 40.1% were enrolled in a school in northern Italy. Almost half of participating residents were enrolled in the second or third year of the five-year program. Over 65% reported interest in deepening their knowledge in each of the proposed thematic areas of primary healthcare. For each area, less than one quarter of respondents (range 5-22%) considered satisfactory the skillsets acquired in that area. Eighty-seven percent reported that the option to do electives in primary health care during the residency was available to them.
Subject(s)
Health Knowledge, Attitudes, Practice , Hygiene/education , Internship and Residency , Preventive Medicine/education , Primary Health Care , Female , Humans , Italy , Male , Surveys and QuestionnairesABSTRACT
BACKGROUND: Little information is available on the effect of a follow-up strategy in celiac disease patients during gluten-free diet. AIMS: To assess 5 year time course of t-transglutaminase antibodies (t-TG) in celiac disease patients enrolled in a community based follow-up program. METHODS: Annual t-TG testing and periodical clinic visit in 2245 patients. RESULTS: Proportion of patients with negative t-TG progressively increased from 83% to 93% during the 5-year follow-up: poor adherence to gluten-free diet (HR 4.764), long duration of gluten-free diet (HR 0.929) and female gender (HR 1.472) were independently associated with serological outcome. In individual patients, 69% tested t-TG "persistently negative", 1% "persistently positive" and 30% "intermittently negative or positive". By applying mathematical modelling to t-TG conversion rates observed in this latter group at beginning and end of the follow-up program, the predicted proportion of t-TG negative population increased from 90% to 95% over 5 years. CONCLUSIONS: Time-course of t-TG serology in the community fluctuates in 1/3 of celiac disease patients suggesting inconstant adherence to gluten-free diet and need of follow-up strategy. Periodical serological and clinical follow-up is a viable and efficacious strategy to promote adherence to gluten-free diet as inferred from time-course of t-TG serology.
Subject(s)
Celiac Disease/blood , Celiac Disease/diet therapy , Diet, Gluten-Free , Adolescent , Adult , Antibodies/analysis , Celiac Disease/immunology , Child , Female , Follow-Up Studies , Humans , Male , Middle Aged , Serologic Tests , Time Factors , Transglutaminases/blood , Transglutaminases/immunology , Young AdultABSTRACT
OBJECTIVE: The Local Health Autority (ASL) of Brescia has activated an innovative method of surveillance, based on the integration ofcurrent databases in a single database, Population Database (BDA), for monitoring the prevalence of chronic diseases in the area. METHOD: The BDA has been set up using automatic record-linkages of databases regarding disease exemptions, drug treatments, hospital admissions and outpatient specialist visits. This enabled us to calculate the prevalence of various chronic diseases (single or grouped) and the gross average expenditure per person for each disease group. RESULTS: Out of the 1,092,201 people in the Brescia ASL, 275,601 had at least one chronic disease (prevalence 252.3/1,000). Diseases ofthe circulatory system were the most frequent (169.1/1,000), followed by diabetes mellitus (36 6/1,000). Having had an organ transplant was the condition with the highest per-person expenditure (Euro 16,170/year). The highest total expenditure was associated with circulatory diseases, because of the high prevalence (Euro 470,377,413). CONCLUSION: A single computerised data base is capable of achieving epidemiological aims (assessing population health status) as well as managerial and health care aims (resources management, control of the appropriateness of services, adaptation of diagnostic-therapeutic methods to international guidelines and standards).
