Characteristics of the health districts in Italy and their implication in primary health care policies: an analysis of socio-demographic trends.

Introduction: The Health District (HD) is a critical component of Italy's National Health Service, responsible for ensuring Primary Health Care (PHC) services in response to community health needs. The Italian government established a national strategic reform program, the National Recovery and Resilience Plan (PNRR), starting in 2022, with a series of health interventions to reorganize the PHC setting, the main reform being the Ministerial Decree 77/2022 (DM77). Our study aimed to provide a description of socio-demographic data and to assess the correlation between HDs, in order to suggest health intervention priorities in PHC reforms. Materials and methods: We conducted our analysis using a cross-sectional record linkage of data from multiple sources to compare organizational and socio-demographic variables. A dataset was created with each of the 21 Italian Regions' HDs data of population, land area, mean age, ageing index, old-age dependency ratio, birth rate and death rate. The Inland Areas Project data was integrated for a socio-economic perspective. Results: Our study identified comparable groups of HDs, considering demographical, socio-economic and geographical aspects. The study provides a baseline understanding of the Italian situation prior to the implementation of DM77. It also highlights that inhabitants number cannot be the only variable to take into account for the definition of Italian HDs organisation and PHC reform, providing intercorrelated variables that take into account geographic location, demographic data, and socio-economic aspects. Conclusion: By acknowledging the interplay of demographic, socio-economic, and geographic factors, policymakers can tailor interventions to address diverse community needs, ensuring a more effective and equitable PHC system.

Distance learning in primary health care: an Italian experience among medical residents to integrate public health and primary health care.

Investing in Primary Health Care (PHC) is crucial for the future of Public Health (PH), although recent studies highlighted the lack of training in PHC within Italian Residency Schools. This article intends to show the experience and impact of a training course focused on standardizing the knowledge of medical residents in Hygiene and preventive medicine regarding PHC. The strength of the intervention was to demonstrate the feasibility of a unique and homogeneous educational path throughout the national territory. From the results of the evaluation questionnaires, a strong approval of the training experience emerged, with a significant improvement in the perceived knowledge of the subject.

Critical pathways for continuous quality improvement: a multicentric analysis on the management of patients with lung cancer in Italian best performing hospitals.

Introduction: Critical pathways (CPs) are effective change management tools used to improve quality in healthcare nationally implemented in Italy in 2015. This study aims to map the country's state-of-the-art regarding the adoption of CPs and to verify the existence of factors that determine the success of their implementation and the relative entity of their impact, by analysing the management of Lung Cancer (LC) as a case-study. Methods: Our methodology followed the SQUIRE guidelines for quality improvement reporting (2015). Starting from the 2017 ranking table published by the National Outcome Program, we selected and included in our sample all Italian hospitals who, according to Ministerial Decree n. 70/2015, met national quality threshold for LC treatment. To investigate regional-level and hospital-level factors believed to be responsible for the successful implementation of a CP, a Google Modules questionnaire was constructed and sent to the selected facilities; subsequently, a web-based research was carried out for missing data. Associations between variables were tested in STATA by means of correlation tests and a linear regression model. Results: 41 hospitals matched our inclusion criteria. Of these, 68% defined an internal Lung Cancer Critical Pathway (LCCP). Our results confirmed the presence of critical success factors that favour the correct implementation of a LCCP. Conclusions: Notwithstanding the availability of CPs, their adoption in routine clinical practice still lacks consistency, suggesting the necessity to resort to digital solutions, to increment the level of regional commitment and workforce commitment and to reinforce quality standards monitoring.

[How are future family doctors in Italy trained? Pilot descriptive study of Postgraduate Training in General Practice.] / Come si formano i futuri medici di medicina generale in Italia? Studio pilota descrittivo di comparazione dei Corsi di formazione specifica in medicina generale.

INTRODUCTION: General practitioner (GP) training programme involves a complex process. In Italy, unlike in other European countries, there is no national core curriculum for the training of GPs and the three-year specific training course in General Medicine (CSFMG) is not equated as a proper specialty. Furthermore, the quality of the CFSMGs is poorly investigated and data are difficult to find/fragment. The aim of this study is to describe and compare GP tranining from two pilot regions (Lombardy and Lazio). METHODS: The study analysed the white and grey literature. For data collection a descriptive grid was created using the characteristics foreseen by current legislation as comparison indicators; the information came exclusively from official and public written data. RESULTS: The analysis reports indicators: structural-organisational; theoretical activity; practical activity; research/guided study; final thesis. DISCUSSION: The most evident fact that emerges is the lack of available (show the gap), public and official information on the GP training, therefore the description and comparison of the basic indicators in the pilot Regions suffers. A learning model based more on minimum time requirements (time-based learning) than on competences to be acquired (competencies-based learning) is evident. Furthermore, the professional/academic profiles of the lecturers are not available and thus comparable; finally, no information on the training methodologies of the frontal/research sessions can be found. CONCLUSIONS: The limitation to only two Regions and the lack of available data do not allow a comprehensive assessment and it would be useful to extend the study on a national scale. However, there is a clear need for improved transparency and evaluation within the GP's training in different Regions through a periodic monitoring system with specific indicators (quantitative and qualitative). The re-establishment/establishment of an independent national observatory on Training in General Practice would be desirable.

Assessing the potentiality of algorithms and artificial intelligence adoption to disrupt patient primary care with a safer and faster medication management: a systematic review protocol.

INTRODUCTION: In primary care, almost 75% of outpatient visits by family doctors and general practitioners involve continuation or initiation of drug therapy. Due to the enormous amount of drugs used by outpatients in unmonitored situations, the potential risk of adverse events due to an error in the use or prescription of drugs is much higher than in a hospital setting. Artificial intelligence (AI) application can help healthcare professionals to take charge of patient safety by improving error detection, patient stratification and drug management. The aim is to investigate the impact of AI algorithms on drug management in primary care settings and to compare AI or algorithms with standard clinical practice to define the medication fields where a technological support could lead to better results. METHODS AND ANALYSIS: A systematic review and meta-analysis of literature will be conducted querying PubMed, Cochrane and ISI Web of Science from the inception to December 2021. The primary outcome will be the reduction of medication errors obtained by AI application. The search strategy and the study selection will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the population, intervention, comparator and outcome framework. Quality of included studies will be appraised adopting the quality assessment tool for observational cohort and cross-sectional studies for non-randomised controlled trials as well as the quality assessment of controlled intervention studies of National Institute of Health for randomised controlled trials. ETHICS AND DISSEMINATION: Formal ethical approval is not required since no human beings are involved. The results will be disseminated widely through peer-reviewed publications.

Interprofessional Collaboration and Diabetes Management in Primary Care: A Systematic Review and Meta-Analysis of Patient-Reported Outcomes.

The global spread of diabetes poses serious threats to public health requiring a patient-centered approach based both on interprofessional collaboration (IPC) given by the cooperation of several different health professionals, and patients' perspective through the assessment of Patient-Reported Outcomes (PROs). The aim of the present study is to evaluate the impact of interprofessional collaboration interventions, for the management of type 2 diabetes in primary care settings, through PROs. A systematic review and meta-analysis was conducted querying the PubMed, Scopus and Embase databases. Out of the 1961 papers initially retrieved, 19 met the inclusion criteria. Interprofessional collaboration is significantly associated with an increase in both patient's satisfaction (SMD 0.32 95% CI 0.05-0.59) and in the mental well-being component of the HRQoL (SMD 0.18; 95% CI 0.06-0.30), and there was also promising evidence supporting the association between an interprofessional approach and an increase in self-care and in generic and specific quality-of-life. No statistical differences were found, supporting the positive impact on IPC interventions on the physical component of the HRQoL, depression, emotional distress, and self-efficacy. In conclusion, the effect of IPC impacts positively on the few areas assessed by PROMs. Policymakers should promote the widespread adoption of a collaborative approach as well as to endorse an active engagement of patients across the whole process of care.