Family doctor: what are your duties and why is it essential for the prevention of chronic diseases?

The role of the general practitioner is crucial in the management of chronic diseases, such as diabetes, heart disease, hypertension. Knowing what its tasks are allows you to use the basic primary care service better and more consciously when you have a health problem that requires continuous treatment over time. Regular check-ups with your GP help chronically ill patients adhere correctly to therapyto monitor the effectiveness of drugs, not to repeat tests unnecessarily and to change incorrect habits.

Not just recipes and certificates

«The most common mistake, after receiving the treatment plan, is to limit contact only to requests relating to filling prescriptions and illness certificates. Depending on the chronic pathology, however, the family doctor should be met every 6-12 months» recommends Alberto Magni, general practitioner in Desenzano del Garda (Bs) and national manager of youth policies for the Italian Society of General Medicine (Simg). The first function of the family doctor is that of intercept risk factors for chronic diseases: high blood pressure, high blood sugar, excess cholesterol, overweight, obesity, smoking, sedentary lifestyle, poor diet, heredity.

Suspicious symptoms

«In the presence of suspicious symptoms, such as increased blood pressure, headache, persistent cough, arrhythmia or urinary disorders, it is advisable to immediately book a visit with your doctor, who, having evaluated your medical history, will decide whether to prescribe an in-depth diagnostic test. The same thing can be done when the patient accesses for a sick certificate, for sporting activity or for renewal of the driving licence” clarifies Magni.

Once verified the diagnosis of chronic disease the simple patient (i.e. who has no other concomitant pathologies or complications) is taken care of by the general practitioner, “without needing to go to the branch specialist” underlines Magni. Citing two examples: «In case of hypertension, the treating doctor prescribes blood and urine tests, electrocardiogram, echocardiogram and ultrasound of the carotid arteries to stratify the risk of organ damage. If there are no signs or dangers of complications, he will take care of setting up the drug therapy directly. While if damage has occurred, such as nephropathy, retinopathy or ventricular hypertrophy, he sends the patient to the cardiologist for a consultation and to share the choice of treatment. Another example is the patient with non-decompensated type 2 diabetes, i.e. with blood sugar levels slightly above normal, to whom the family doctor prescribes standard therapy.”

Integrated management

While more complex chronic patients, however, must be evaluated and followed by specialist centres but always with a view to integrated management with the general practitioner as supervisor and coordinator of care. «The family doctor – explains Magni – verifies that the patient has understood the treatment path defined by the specialist and the methods of taking the drugs, who does not skip therapy and does not have adverse reactions. Check that there are no interactions between drugs that compromise the treatment and that the patient does not have to repeat identical tests requested in close time by the various specialists in charge of him”.

Landmark

It therefore remains a point of reference for all chronically ill patients. «There are those who are discharged from hospital with the instruction to take insulin, but are not educated on how to take it correctly. Those who take the gastroprotector after meals rather than on an empty stomach, nullifying its effect, those who take cardioaspirin before eating, with the risk of causing gastric ulcers, or in combination with other anti-inflammatories, increasing the risk of gastrointestinal bleeding, and those who smoke even though having had a heart attack. The doctor must make the patient responsible and help him understand the importance of taking medicines in the indicated ways and times and of having a healthy lifestyle »he concludes.

The former medical guards also helped

To address the shortage of family doctors, a series of measures have been launched. The first, in force until 12/31/2026, allows the Regions to raise the maximum number of patients is up to a thousand for general practitioners who also provide a continuity of care service with a guarantee of 24 hours per week (in derogation from the ceiling of 650 patients).

“The measure affects over 7 thousand professionals and allows around one million more citizens to have a family doctor” says Silvestro Scotti, general secretary of the National Trade Union Federation of General Practitioners. Even graduates enrolled in the training course in General Medicine can have a maximum of one thousand patients. «The provision expires on 12/31/2024. We hope that it will be extended» comments Scotti. Also the new national agreement for general medicine provides for the Regions to raise the maximum number of beneficiaries from 1,500 to 1,800. Finally, in the absence of employable medical personnel, affiliated doctors can remain at work until they reach the age of 72 (the exemption expires at the end of 2026).

He is consulted on average nine times a year

In Italy, in 2021, the average number of contacts between general practitioners and patients it was 9 per year. The Simg research institute estimates this in the latest “Health search” report. The frequency increases as the age of the patients advances, reaching almost 22 annual contacts for men and 20.8 for women among those over 85 years of age. Half of the reports are represented by outpatient visits, 40% from requests for drugs and specialist services and the rest from telephone consultations. The pathologies for which patients most often turned to their GP in 2021 were, among others: uncomplicated hypertension (17.9% of contacts), type 2 diabetes (7.2%), dyslipidemia (5, 6%), ischemic diseases (4.1%), thyroid dysfunction (4%), gastroesophageal reflux disease (3.9%), back disease (3.7%), prostate disease (3.7%), depression (3.1%), cancer without metastasis (3.1%), osteoporosis (2.9%), atrial fibrillation (2.8%),