1
|
Addressing health inequities in Bologna: a mixed-method, multi stakeholder, action-research approach. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
A large body of literature shows how lower socioeconomic classes have higher incidence of mortality and morbidity, and how worse health outcomes linked to barriers in accessing healthcare particularly affect the most vulnerable groups. Despite such evidence, in many a context health inequalities have continued to increase. Processes that better link knowledge with action are therefore needed.
Methods
An interdisciplinary, interprofessional, interinstitutional group was created involving the Public Health Department and the Center of International Health of Bologna. In 2017-19, the group carried out a project to document and tackle local health inequities, structured in two phases: a first one of quantitative analysis of health inequalities using routinely available data, and a second one of qualitative research in selected areas of the city. An action-research approach was embedded throughout the project, with periodic evaluations to ensure progress towards the intended results.
Results
Phase 1 results show significant differences in terms of disease burden and service use between the North, East and West periphery of the city compared to the center and South. These differences mirror the urban distribution of wealth/deprivation, measured through different indicators (education, income, presence of immigrant population). Results also show concentration of the worst health outcomes and healthcare access indicators in some areas of the city, which also have higher presence of social housing. Phase 2, started in January 2020, is using phase 1 results to inform both a qualitative analysis and a participatory process in 6 areas of the city selected among those with worst health indicators.
Conclusions
Our experience shows that addressing the issue of health inequities through a mixed-method, multi stakeholder and action-research approach may lead to greater integration of research findings and evidence into healthcare policy and practice, towards health equity.
Key messages
Working across disciplines, roles and institutions may bring added value to the complex field of health inequities, when approached with the aim of moving from knowledge to action. Relying on routinely available data may open a route for the replication of our experience and for its use to monitor the impact of interventions aimed at reducing health inequities.
Collapse
|
2
|
An individual care plan for a high risk elderly population in the Local Health Authority of Bologna. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Issue
Fragility is a major challenge that demand a comprehensive public health response, since a high rate of population is aging and becoming vulnerable.
Description of the Problem
The Local Health Authority of Bologna, about 850,000 inhabitants, has implemented a new qualitative and quantitative Project on fragile patients. Frailty was measured by the “Risk Profile of the Emilia-Romagna region,”, an algorithm that provides a risk index, based on patients'record, which divide population in risk categories (high/very high, moderate and low risk) of hospitalization. The 585 General Practitioners (GPs) have enrolled their fragile patients with high and very high risk (about 6% of the population). GPs and other healthcare professionals are asked to define an Individualized Care Plan (ICP) according to an integrated and multi-professional management perspective. Patients' and healthcare professionals' subjective experience was collected throughout a structured interview.
Results
From October 2018 to April 2019, 260 patients were included in the project and they received a ICP which included different interventions such as: integrated nursing care (105), nursing care in chronic ambulatory (55), community hospital care (9), social assistance (92), physiotherapy (88), specialist activities (114). Qualitative data highlighted high level of satisfaction both in patients and clinicians. The strengths of the Project are: 1) an integrated management (with a multi- professional team) of frailty population, 2) proactive and individualized treatment plan. Limitations are: 1) different approaches among clinicians in the Local Health Authority of Bologna with possible inequalities of accessibility to the treatment; 2) difficulties in the relationships among clinicians.
The early recognition and the specialistic management of the fragile population have to be considered a priority in health practice in order to provide effective medical intervention.
Key messages
Individualized Care Plan (ICP) and integrated and multi-professional management. Importance of fragility early recognition.
Collapse
|