Cross sectional study on arterial hypertension in a general practice setting

An observational study on arterial hypertension (AH) in the setting of general practice takes advantages of reaching easily the involved population and of getting information from data recorded in the physicians’ databases. Their results could be different from data obtained in specialist settings. The aim of the study is to obtain some prevalence indexes regarding AH and verify if they are consistent with literature. Researchers administered a questionnaire and measured the blood pressure to 478 individuals, randomly selected from the patients’ lists of 17 general practitioners (GPs). Patients with high value of AH but not acknowledged as hypertensive patients (HP) were invited to come back for two new measurements. Some obtained indexes are not consistent with literature, particularly: i) 97.34% of the acknowledged hypertensive patients receive a drug treatment; ii) the percentage of HPs not identified by GP is very low (5.05%); iii) the prevalence of acknowledged HPs at target is higher compared to literature (64.89%). The study shows that the knowledge of clinical history of patients recorded by GPs enhances the rigor of the scientific methodology.

[Chronicity practices - The integrated management for chronic conditions in the health district of Campi Salentina (Lecce ASL)]

A program concerning the care management of chronic conditions has been carried out in the primary care setting, starting from previous projects based on delivering integrated care and on promoting patient empowerment. The chronicity practice, which is based on common facilities and time of work, is aimed to improve communication about individual care plan of patients, to improve adherence to the treatment and to the follow-up. The expected outcome are: the increasing adherence to healthy lifestyle and doctor's recommendations, improved clinical outcome, satisfaction of patients and health professionals.

Patient empowerment, an additional characteristic of the European definitions of general practice/family medicine

Growing evidence supports the inclusion of patient empowerment as a key ingredient of care for patients with chronic conditions. In recent years, several studies based on patient empowerment, have been carried out in different European countries in the context of general practice and primary care to improve management of chronic diseases. These studies have shown good results of the care model, increasing patient and health professionals' satisfaction, adherence to guidelines and to treatment, and improving clinical outcomes. In 2011, the Wonca European Council included as the twelfth characteristic of the European definitions of general practice/family medicine: 'promote patient empowerment'. The aim of this paper is to clarify the meaning of 'patient empowerment' and to explain why family medicine should be considered the most suitable setting to promote it. The inclusion of patient empowerment as one of the essential characteristics of general practice fills a conceptual gap and clearly suggests to the European health care systems a tested model to face chronic diseases: involving and empowering patients in managing their own conditions to improve health and well-being.

[The quality of interdisciplinary communication]

Because of a continued increase of complex patients and the development of many areas of sub-specialities in medicine, the use and quality of interdisciplinary communication has been found to be lacking, especially between hospital and primary care physicians, causing a significant gap in the documentation, coverage and care of individual patients. The study focuses on state of the art interdisciplinary communication, with consideration given to current used tools and priorities. An ad hoc questionnaire surveyed 118 physicians about their profession, the types of patients, the frequency of complex cases, the tools used to communicate with each patient and how the physicians rated these tools. The rate of patients needing interdisciplinary communication is 17% of the entire patient sample, all of this percentage having complex health care needs (terminally ill, disabled, often without a personal support network). Physicians frequently used paper documents, despite their lack of quality, as well as the telephone to communicate with other colleagues. Computer devices were scarcely used. Many Doctors (71%) value the actual interdisciplinary communication of low quality, despite the fact that it is considered to have a significant influence on the quality of health care. New tools and methods are needed. For example, dedicated standards of multidisciplinary and multi-professional Continuing Medical Education (CME), as well as the use of computer tools allowing for shared clinical records.

Feasibility and effectiveness of a disease and care management model in the primary health care system for patients with heart failure and diabetes (Project Leonardo)

Purpose

Project Leonardo represented a feasibility study to evaluate the impact of a disease and care management (D&CM) model and of the introduction of “care manager” nurses, trained in this specialized role, into the primary health care system.

Patients and methods

Thirty care managers were placed into the offices of 83 general practitioners and family physicians in the Apulia Region of Italy with the purpose of creating a strong cooperative and collaborative “team” consisting of physicians, care managers, specialists, and patients. The central aim of the health team collaboration was to empower 1,160 patients living with cardiovascular disease (CVD), diabetes, heart failure, and/or at risk of cardiovascular disease (CVD risk) to take a more active role in their health. With the support of dedicated software for data collection and care management decision making, Project Leonardo implemented guidelines and recommendations for each condition aimed to improve patient health outcomes and promote appropriate resource utilization.

Results

Results show that Leonardo was feasible and highly effective in increasing patient health knowledge, self-management skills, and readiness to make changes in health behaviors. Patient skill-building and ongoing monitoring by the health care team of diagnostic tests and services as well as treatment paths helped promote confidence and enhance safety of chronic patient management at home.

Conclusion

Physicians, care managers, and patients showed unanimous agreement regarding the positive impact on patient health and self-management, and attributed the outcomes to the strong “partnership” between the care manager and the patient and the collaboration between the physician and the care manager. Future studies should consider the possibility of incorporating a patient empowerment model which considers the patient as the most important member of the health team and care managers as key health care collaborators able to enhance and support services to patients provided by physicians in the primary health care system.

[Indicators of communication and degree of professional integration in healthcare]

According to the chronic care model, improving the management of chronic illness requires efficient communication between health care professionals and the creation of a web of integrated healthcare The aim of this study was to identify an efficient methodology for evaluating the degree of professional integration through indicators related to communication between healthcare professionals. The following types of indicators were identified:-structure indicators to evaluate the presence of prerequisites necessary for implementing the procedures -functional indicators to quantitatively evaluate the use of communications instruments-performance indicators Defining specific indicators may be an appropriate methodology for evaluating the degree of integration and communication between health professionals, available for a bargaining system of incentives.

Integrating patient empowerment as an essential characteristic of the discipline of general practice/family medicine

BACKGROUND

Efforts to improve the quality of healthcare for patients with chronic conditions have resulted in growing evidence supporting the inclusion of patient empowerment as a key ingredient of care. In 2002, WONCA Europe issued the European Definition of General Practice/Family Medicine, which is currently considered the point of reference for European health institutions and general medical practice. Patient empowerment does not appear among the 11 characteristics of the discipline.

OBJECTIVES

The aim of this study is to show that many characteristics of general practice are already oriented towards patient empowerment. Therefore, promoting patient empowerment and self-management should be included as a characteristic of the discipline.

METHODS

The following investigation was conducted: analysing the concept and approach to empowerment as applied to healthcare in the literature; examining whether aspects of empowerment are already part of general medical practice; and identifying reasons why the European definition of general practice/family medicine should contain empowerment as a characteristic of the discipline.

RESULTS

General practice/family medicine is the most suitable setting for promoting patient empowerment, because many of its characteristics are already oriented towards encouraging it and because its widespread presence can ensure the generalization of empowerment promotion and self-management education to the totality of patients and communities.

CONCLUSION

"Promoting patient empowerment and self-management" should be considered one of the essential characteristics of general practice/family medicine and should be included in its definition.

Validation of the Italian version of the EUROPEP instrument for patient evaluation of general practice care

OBJECTIVE

To describe the validity and reliability of the Italian version of the EUROPEP instrument for patient evaluation of general practice care.

METHODS

A survey was performed among patients who visited a general practice (n=983), using the 23-item EUROPEP questionnaire. The scores are aggregated in two dimensions: "clinical behaviour" and "organization of care". The cultural adaptation of the questionnaire into Italian has been performed by using the formal translation procedures applied in other European countries. Data were analysed with respect to item response rate, item-scale correlation, internal consistency reliability and construct validity of the instrument.

RESULTS

The item response rate was good for 17 items, acceptable for four items and problematic for one item. The item-scale correlation largely exceeded a value of 0.40 for all items in both scales. The internal consistency of the aggregated scores was also very good, the reliability coefficients being 0.95 for "clinical behaviour" and 0.90 for "organization of care". As expected, older age and better health status were associated with more positive evaluation of care.

CONCLUSION

Our study confirms that, even in its Italian version, the EUROPEP is a valid and easy-to-use instrument for gathering information on patients' experience with and evaluation of general practice care.