2023-06-16 15:10:06
“Chronicities are a real emergency: 24 million people in Italy are affected and over half have more than one; almost 9 million have serious forms; they cost health care over 65 billion and are increasing, so much so that in five years there will be at least a million more than today. And they are present in all stages of life: 8 million are chronically ill under-18. However, the National Chronicity Plan (Pnc) is at a standstill, despite the fact that chronic diseases are also a goal of Mission 6 of the Pnrr. The 2023-2027 National Oncology Plan (Pon) and the 2023-2025 National Plan on Rare Diseases (Pmmr) have been updated, but that of chronicity which should update the responses for almost half of the Italian population is still on standby”. So Tonino Aceti, president of Salutequità in a note.
The verification of the essential levels of assistance (Lea) for which the Ministry of Health has recently communicated the data collected with the New guarantee system (NSG) – details the note – shows a gloomy picture: according to the analysis of the Osservatorio Salutequità the combination of the indicator on lifestyles with six non-compliant Regions and a territory in trouble, with four Regions well below the sufficiency, and practically half of the Regions (9) with worsening in the scores relating to district assistance compared to 2019, show that the inevitable challenge is precisely chronicity. Assistance – continues the note – worsens in Sicily, Sardinia, Abruzzo, Puglia by more than 10 points between 2019 and 2021; in the South the deterioration is generalized, splitting Italy in two with the only exception of Basilicata which increases its score by almost 14 points. The Public Administration of Bolzano (+17.16) and Tuscany (+6.52) also did well.
According to the report of the Salutequità Observatory, access to the territory is more complicated, the use of the emergency room is increasing, data relating to adherence to Pdta is missing. Emergency room access rates have returned to pre-pandemic levels, a symptom of their inappropriate use. Among the data published by the Ministry of Health of the Nsg relating to 2021, then, those for monitoring the diagnostic therapeutic care pathways were excluded, the last analysis of which dates back to 2020. Yet, it is a central indicator not only of the process (although the territory is still largely measured by deducing the quality of care based on what happens in the hospital), but also to verify the impact of the pandemic on people with chronic diseases and on the “resilience” of the NHS towards these patients and of the impact of the difficulty in restoring productivity – in terms of performance – to pre-Covid levels.
The Oncology Plan and the Rare Disease Plan – continues the note – have a defined time frame, a start and end date, with a precise indication of when to update them, providing deadlines for making the “coupon”, also limiting blackout situations in case, for example, of delays in the renewal of the control room in whose hands is the updating and verification of the National Chronicity Plan. Furthermore, both can count on clear targeted resources (10 million a year for the implementation of the Pon, 25 million a year for Pnmr), something that the Pnc has lacked so far. “If we want to give legs to the National Chronicity Plan, the way is to finance it – underlines Aceti – similarly to the other Plans, to ensure its implementation on the one hand and on the other provide for a stringent measurement/evaluation to monitor its progress and use this lever to enforce it”. But for the president of Salutequità, “transparency and priority in the selection of pathologies are also necessary
The criteria specified by the ministry for pathologies to be integrated in the list of the second part of the Plan – concludes the note – are the lack of existence of specific planning acts at a national level, the epidemiological relevance, the economic/welfare weight, the difficulties of diagnosis and access, etc. It is important that these criteria are applied in a transparent way, in order to raise the bar of rights, make better use of resources and ensure equity. It is a good opportunity to give important signals with respect to, for example, pathologies strongly linked to gender; contribute to eliminating stigma or prejudices on disabling pathologies, even from a social point of view, stripping them of their aesthetic meaning and looking at the functional impact as in the case of psoriasis and starting a reasoning on the opportunity to include those onco-haematological pathologies which for them nature are defined as chronic”.
A useful starting point for “identifying the pathologies on which to focus attention are the recommendations of the Parliamentary Intergroup on chronicity. Among the pathologies to be integrated into the Plan are mentioned, for example, multiple sclerosis, psoriasis, chronic headache, nasal polyposis, asthma also in adults, obstructive sleep apnea” recalls Aceti. The Salutequità Observatory is created with the unconditional contribution of UCB Pharma, Bristol Myers Squibb and Sanofi.
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