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Analysis and perspectives of GPs gathering models in Italy according to the latest

Pisa, 30-31 August 2010. Analysis and perspectives of GPs gathering models in Italy according to the latest Italian National GPs Joint Agreements. Mazzeo M.C.*, Ceccarelli A.* °, Cicchetti A.* °, Le Rose C.*, Milillo G.*.

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Analysis and perspectives of GPs gathering models in Italy according to the latest

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  1. Pisa, 30-31 August 2010 Analysis and perspectives ofGPsgatheringmodels in Italy accordingto the latest Italian National GPs Joint Agreements Mazzeo M.C.*, Ceccarelli A.* °, Cicchetti A.* °, Le Rose C.*, Milillo G.* * GISAP – Independent Group for the Study of Primary Health Care ° Catholic University of Sacred Heart - Rome

  2. Gruppo Indipendente per lo Studio dell’Assistenza Primaria Independent Group for the Study of Primary Health Care Established in 2009, currently its members are: Maria Concetta Mazzeo: President Elio Guzzanti: President of the Scientific Committee Americo Cicchetti: Founding member Giacomo Milillo: Founding member GISAP Goals: Promotion and fulfillmentofresearch and studyactivitieson the organization, economics and healthcare policy, particularly with regard to an in-depth examination of problems related to the promotion and development of Primary Health Care, alsothrough the organizationofeducational activities. For more information, visitour website www.gisapitalia.it

  3. Purposeof the study This study analyzes the collaboration between GPs and other Primary Health Care (PHC) professionals compared to what Italian National GPs Joint Agreements plan and according to some Regions’ experiences.

  4. Background • Evolution of the context: • Institutional • Constitutional Law 3/2001 and Law 42/2009 • Organizational • Financial • severe constraints on the Italian budget New trends: • in demography • significant increase of population aged >65 years • in healthcare needs Source: Eurostat (2006-2007) Need to rethink the Primary Health Care providing mechanisms

  5. Background General Practice has been working for several years to define health care providing models: • based on the gathering of different professionals and skills; • in which the GP is responsible of the achievement of a “professional integration”; • which are aimed at proposing to citizens a more complete and qualified service. Effectiveness – Efficiency - Accountability

  6. Background “Functions” to be realized by GPs • Clinical: activities of prevention, diagnosis, care and rehabilitation (h24; 7 days out 7; 365 days per year); • Organizational: creation of adequate information flows and contribution to services planning; • Educational: promotion of healthy life styles and assignment of responsabilities to patients and citizens.

  7. Methods A perspective analysis of gathering models was performed and compared to those experienced in some Italian Regions through Regional GPs Joint Agreements.

  8. Findings Italian National Joint Agreements considered voluntary forms of collaboration between GPs linked to financial incentives diversified according to the organizational complexity of gathering. 2000-2008

  9. Findings National GPsJoint Agreements2000-2008 • SimpleAssociation (Associazione Semplice): • 3 to 10 GPs in theirownstudies • Regular peer-reviewmeetings • Network Association (Medicina in rete): • 3 to 10 GPs in theirownstudies • Network computer connection toalloweach GP toaccesspatients’ medicalfiles • GPs Group (Medicina in gruppo): • 3 to 8 GPs in a single building • Possibilityto share assistants, nurses, medical and computer technologies

  10. ComplexmodelsofGPsgathering The “Equipe”proposal (2000) “Local structure characterized by a multidisciplinary and interprofessional integration, able to provide complete answers to population health needs.” (National GPs Joint Agreement, 2000) Severalregionalmodels

  11. Equipe Gathering of GPs, Paediatricians, and other professionals aimed at ensuring the integration of social and health interventions in a determined area.

  12. ComplexmodelsofGPsgathering LocalPrimary Care Units (UTAP): 2005 Experimentalgatheringmodelsdefinedas: “Integratedstructuresfor the supplyofPrimaryHealth Care, formedby the gatheringofseveraldoctors (GPs, Paediatricians, Specialists) who work in a single building, ensuring a high levelofintegrationbetweengeneralpractice and secondary care.” (National GPsJoint Agreement, 2005)

  13. LocalPrimary Care Units • Structured in a single building • Have a basicorganizationalstructure • Have a basictechnologicalequipment Purpose: Toensure a full continuityof care; an appropriate management ofclinicalpathways; Toprovide home and institutional care; some secondary care.

  14. ComplexmodelsofGPsgathering PrimaryHealth Center (Casa della Salute) New experimental model provided by the Ministry of Health Programme “A new Deal for Health”, presented to the Parliament in June 2006. Main Goal: Topromote, through the contiguityoffacilities and ofprofessionals, the integrationbetweenessentiallevelsofhealth and social care.

  15. PrimaryHealth Center Polyvalentstructureabletosupply the and toensureContinuityof Care and activitesofpreventionto a catchment area of 5-10.000 inhabitants. multidisciplinaryapproachtopopulation care needs

  16. Findings • Although these models developped among GPs the attitude towards teamwork, time highlighted their limits. • In few cases these models succeeded in minimizing negative effects of GPs competition, which is still the main obstacle to a full GPs collaboration. Limitsof the voluntarymodels ofGPsgathering

  17. Findings Introductionof the MultidisciplinaryPrimary Care Units - PCUs (Unità Complesse di Cure Primarie - UCCP): • mandatory; • describedasan “extended team” ofprofessionals; • eachprofessionalperformsdifferent and integratedfunctions. 2009-FUTURE

  18. Findings Multidisciplinary Primary Care Units • Gathering of GPs, Paediatricians, and Specialists; • Can be defined as an “extended team” of professionals having their own tasks but the same mission; • Don’t have a predetermined configuration: can be a single building or a network structure with headquarters in which some activities, technologies and services are concentrated.

  19. Discussion Multidisciplinary Primary Care Units should provide a more complete and qualified answer to population needs through the provide of a 7/7d and 24/24h care by professionals who, thanks to the support of nurses and other professionals, could be appropriately concentrated on their clinical functions.

  20. Conclusions The new Multidisciplinary Primary Care Unit model provided by the 2009 Italian National GPs Joint Agreement must be: • tested in some Regions in order to be validated; • implemented at the national level taking into account the singularities of each territory.

  21. How to make the “dream come true”? How to share out work? How to define tasks and roles? Who has the power (or the duty) to take decisions? What kind of (and how much) hierarchy? How to manage new and specific situations? Conclusions

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