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This policy paper aims to compare what policies are developed in Italy for the management of chronic patients in order to improve population health, quality of care and patient experience and reduce per-capita cost. The paper also aims to identify the key trends and evolutionary trajectories across the Country. Methodology: The analysis focuses on 10 Italian Regions and the time span of observation is 7 years (from 2014 to 2020). Data collection and analysis adopts mixed methods in order to have a more in-depth picture of the contextual factors, mechanisms and outcomes. It includes a desk research of the literature and documentary analysis; semi-structured interviews; a theory driven evaluation of 12 programmes identified at the regional level; and a Consensus Conference to discuss and validate the results with an Expert Panel Group. Conclusions: The paper firstly describes the main policies developed in Italy in the last seven years; secondly, it discusses six main trends and clusters them into three strategies: demand management strategies; strategies to improve the management of comorbid and frail patients; and strategies to improve the coordination between levels of care and the patient journey; thirdly, it discusses eight trends and evolutionary trajectories which are now emerging. [ABSTRACT FROM AUTHOR]

Purpose: This paper illustrates some guidelines for the implementation of Consultation-liaison services in contexts where GPs work alone. We present some activity data of our experience in the period 1999-2004 and a critical evaluation of what works and what does not work. Context: In Italy single-sited spontaneous initiatives of co-operation and integration between general practice and psychiatry have been implemented in many regions. Recently, the Italian Health Care Government has begun to encourage integration between primary and secondary care for the management of mental health. The Bologna Consultation-liaison Service opened in 1999 in one area. The service was first located in the Community Mental Health Centre and subsequently in a medical non-psychiatric outpatient service. In 2002, the services were implemented in the overall city area, and the Bologna Consultation-liaison Service had its own office in the centre of the town. Data source: Data have been collected by reviewing clinical charts. They include clinical (mental status examination, progress notes) and socio-demographic data, assessment scales that measure psychological distress and disability, reports for GPs, and consultation outcome. Conclusion: A consultation-liaison service like the one proposed in this paper could contribute to an efficient and fully-integrated collaborative management of common psychiatric disorders, reducing the use of mental health services. [ABSTRACT FROM AUTHOR]

Over the last decade, increased attention has been placed on measuring and improving the health care experience of patients. Patient experience is an integral component of service quality and is increasingly recognised as one of the three "pillars of quality in healthcare" alongside clinical effectiveness and patient safety. Despite the complexity surrounding which definition to embrace or which components/constructs to measure, there is general agreement that patient experience in a health care context is formed during the moments when the operation (health service) and consumer (the patient) meet. The series of encounters and consecutive events or steps (activities, interventions, or staff interactions, for example) can be viewed as the patient journey or process of care. Patients living with complex chronic diseases typically receive care from many providers and move frequently within health care settings, so understanding the full impact of a disease on patient experience, in its widest possible context, is central. Gaining a clear picture of the entire patient journey, beginning with characterizing the initial impact of the disease and then mapping the pathway to diagnosis, is essential to identify the critical challenges that patients and their families face while on the road to discover and receive effective treatment and care. The paper used a customer experience mapping in order to understand the journey of patients with HCV (Hepatitis C Virus) and NASH (Nonalcoholic steatohepatitis) within 10 healthcare organizations (hospital trusts and local health authorities) in Italy. The overall aim was to gather information on the real patient journey and on the health and social services used in order to analyse what service users really think and feel, moving through to identify the key conditions for improving the care management of chronic patients. We employed mixed methods in order to exploit a multiple case-study analysis. These included a literature review of theoretical frameworks to map the patient journey and an in-depth analysis of 10 integrated care pathway conducted through local documents analysis, focus groups with professionals and patients, interviews with key managers of the services, and a survey distributed to patients and caregivers. Poor communications, incomplete transfer of information, inadequate education of health professionals, limited access to expertise services, and the absence of a reference contact to ensure continuity of care all contribute to patient dissatisfaction along the journey. The engagement of patients has a central role in the change process within healthcare organizations especially for the definition of integrated clinical pathway. The project underlined firstly that healthcare organizations should respect and take into account patient perceptions, preferences and expectations and consider their emotional journey while defining the integrated clinical pathway; secondly, that the experience of patients could be a driver to implement operation and strategic models to redesign the integrated care pathway and finally, linked to this, that there is a growing need to plan strategies within the healthcare organization to internalize the point of view of patients within the broader clinical and managerial process. [ABSTRACT FROM AUTHOR]

Introducing the Family Health Nurse Concept in Europe Purpose Presenting the Family Health Nurse FHN as advance role of nursing, the paper aims to stimulate reflection on the potential of this role and the best model to pursue for its introduction in European Health Systems. Objectives: inform about the role of FHN and its potential contribution to the development of prevention strategies and integrated care for all the population, presenting studies results on case management and good practises in Europe. Background: Ageing of population, economic recession, advances in technology, increasing complexity of health needs, structural changes in health care delivery, underscore the search for innovative, cost-effective approaches to health care worldwide. Maintaining the current mode of service delivery will be insufficient to meet the health demands of the future. As part of the Health21 health policy framework, the WHO Europe Office introduced the Family Health Nurse (FHN) a key professional in achieving the overarching aims of Health21: "promoting and protecting people's health throughout the course of their lives; and reducing the incidence of and suffering from the main diseases and injuries" (WHO Regional Office for Europe,1998, p. 8). FHN plays multidimensional activities focused not only on the individual, but also on families, groups and populations to support promotion of health and is proactive in primary, secondary and, above all, tertiary prevention of disease/illness and disability and to maintain an individual in his or her family and community. (Martin 2013) The FHN is a "case manager" able to read, assess and respond to the health needs of citizens and families, to support the autonomy, to coordinate interventions of health and social services, to activate associations of the territory, friendship and neighbouring networks , to control the passage of information and the continuity of care in case of hospitalization, to provide personalized advice and assistance to self-help and for structural improvements, housing and organizational changes necessary for a more sustainable coexistence. Integrated Care needs certainly policies, structural organizations and tools, but also actors that can realize the contact between services and people: a role that FHN, if recognised as a OMS -Eu 21 proposed, could play. To reach these goals is important an advanced learning program for nurses, because the role is different from district and home visiting nurses working in the primary care. The University San Luigi Gonzaga of Turin offers, since 2005, a post graduate course in Family and Community Nursing , called 1°level Master. The program is very stimulating, with the aim of not only to give more knowledge, but to enable a personal growth and learning "out the box" thinking to find creative solutions. Tele-health and ICT teachings have been introduced in the current edition of the Master. Following the Turin experience, 5 more Universities are now launching the program. In order to support the introduction of the role, AIFeC and Turin University, have built a network between universities, health service managers, district nurses, GPs associations, citizens associations, unions and colleges of nurses and have been given consulting for small projects all over in Italy because many studies and analyses identify in inter-professional issues the big obstacle for change. (OECD. 2010) In Sicily and Lazio Region two drafts law have been presented on FHN. International contacts have been established with Spain, Portugal, France and Scotland Universities and Local Health Services. In Spain, Family and Community Nurses have a strong tradition and in 2010 a new post graduate course has been launched. The program lasts two years and is residential, with many courses and internships in common with General Practitioner Physician students. Where the role is fully implemented, has been proved the satisfaction of citizens and other health professionals as GPs and social Workers. Scotland has been pilot of OMS EU study in 2006 and in 2011-2013 the University of the West of Scotland led the European Family Health Nursing Project with Armenia, Austria, Germany, Italy, Poland, Portugal, Romania, Slovenia, and Spain as partners. University of the West of Scotland is launching now a MSc in Family Health, first in Europe. Conclusions: The FHN , as recommended by WHO-EU Health 21, could be a key professional with GPs , for Integrated care and health promotion, strategic to tackle the demographic challenge in Europe. In some countries has been trained but is still not acknowledged and fully used the potential of the role. Many nurses figures are employed in primary care, with important results, such as of palliative care, case management, ChC M, Family Nurse Partnership, Nurses Clinics, Community Nurses, Home Care etc, but are focused on illness and there is lack a "citizen-family centred" coordination and proactiveness. Mladovsky and colleagues (2009) reinforce that the challenges for the countries across Europe will be significant and that further research and learning from the experience of each country are essential. A large research project based on developing FHN workforce for integrated care and on collecting data about cost-effectiveness, could be the way to fostering the acknowledgement of the role in Europe. [ABSTRACT FROM AUTHOR]

The paper provides an in-depht explorative analysis of the challenges and requirements to make Integrated Practice Units IPU Porter, 2013 work, relying on evidence from a research on Breast Cancer Integrated Care Pathways ICPs. The latter involved 4 provinces in Italy and the unit of analysis has been the breast cancer ICP, where "integrated" means yet the services' integration, from preventative screening to end of life care, yet integration between the province Local Health Authority LHA and the public hospital where autonomous from the LHA, by setting up inter-organisational multiprofessional groups for designing a common ICP. Provinces have a middle size with on average 400k to 500k inhabitants. In all provinces, Breat Units BU according to EUSOMA are in place and, in two provinces, two BUs coexist. Indeed, in some cases there are private accredited hospitals with recognised BU. It is largely recognised that BU today represents the paradigmatic example of IPU. The study, based on quantative and qualitative analyses of ICPs, according to the PHM, provides key lessons over the efficacious roles of IPUs to deliver ICPs. The predominant understanding tackles out that the IPU model can not work efficaciously outside Accountable Care Organisations, featured by an integrated commissioning function over all services required by the ICP across different providers either public or private and by the capacity to steer and nudge patients' choices. This understanding holds a crucial role for the Italian NHS, wherein LHAs are gaining increasing value as Health Population organisations, enlarging the population served and value chain of services provided. In this line, the study provides four lessons. Firstly, IPU as BUs actually does not include all services required as for screening or radiology services: the professional responsibilities and services are fragmented and the BU is not always able to manage effects as drop-out or patients shopping around. The solution of interorganisational tumor boards are not largely spread-out. Secondly, this fragmentation largely belongs to the context setting, yet from the geography or the urbanisation level of LHA, which can influence the IPU's efficacy; yet form the local path-dependency in setting-up agreements of integration/collaboration among providers and/or the LHA's commissioning capacity and power. Third, whereas patient choice is a value and would be recognised, in most cases what can be observed is that most of the women shop around for accelerating some diagnostics more than seeking for centres of excellence, and in any case the latter usually are the most literate persons who maintain a contact with local services. Finally, the IPU model has enhanced the competition with the private providers, but given the mission of the IPU, new competitive patterns are emerging: namely a competition for the market but within targetedservices, and not the overall ICP. Private IPU would not be able to provide full IPC in a quasi - market as the Italian NHS. Indeed, the requirement for public providers to set up IPU/BU hinders any collaborative-competitive pattern unless it will not be promoted directly by the LHA, as commissioner, according to the ACO model. [ABSTRACT FROM AUTHOR]

The abstract presents results of the "InterQuality Project - International Research Project on Financing Quality in Healthcare" funded by the 7th Framework Programme (FP7) for Research and Technological Development of the European Union. Grant Agreement No: HEALTH-F3-2010-261369 Objective: To assess reliability, validity and completeness of data on pharmaceutical benefit financing components of health care in United States, United Kingdom, Denmark, Germany, Italy and Poland Theory: Information and guidance used by authorities for decision making in the financing of pharmaceutical care should be reliable, valid and complete. Methods: A systematic review of literature published in the last 10 years, found electronically in Medline, Embase, the Cochrane Library and SCOPUS, supplemented by a manual search, was conducted. Quality of publications was critically appraised using PRISMA [1], MOOSE [2] and STROBE [3] checklists. Contents of found literature were assessed in terms of consistency, coherence and strength. Results: In total, 439 full text publications were included, of which 198 papers were assessed for quality. Of these, 24,6%, 31,2% and 22,1% publications presented high levels of: consistency, coherence and strength, respectively, and 4,3% presented concurrently high levels of all assessed areas. Several areas of weak data availability were identified. Discussion: No comparable analyses were found. Credible data were often unavailable. A questionnaire and a template helpful to collect data where more information is needed were developed, validated and will be sent to experts from InterQuality Consortium countries. Conclusion: To improve the quality of information available to decision makers, so that it is more credible, multiple sources should be used. [ABSTRACT FROM AUTHOR]