25% of the population (15 million Italians) lives with a skin disease, approximately 6 million deal with a chronic inflammatory disease. Acute (e.g. scabies) and chronic (e.g. psoriasis, vitiligo) dermatological conditions can lead to social stigmatization, poor quality of life and decreased work productivity. Not only that, chronic autoimmune skin diseases are accompanied by comorbidities and an increase in risk factors that can be avoided with effective and timely diagnosis and treatment. Despite their high incidence and prevalence, there is a lack of good quality data for these diseases. Even the official Istat and ISS surveys on the spread of chronicity do not include chronic skin diseases, unlike diabetes, hypertension and acute myocardial infarction.
This is what emerged during the meeting ‘Equity Group – Chronic Skin Diseases’ which took place in Rome in the presence of experts, dermatologists, patient associations, institutional representatives, politicians and representatives of the health professions involved in assistance, and made possible thanks to the unconditional contribution of Bristol Myers Squibb, Incyte, UCB Pharma.
“For these patients, access to care is becoming more difficult due to a lack of attention in national and regional planning,” says Tonino Aceti, president of Salutequità. “Furthermore, we have seen a drastic reduction in dermatological visits by the NHS in 2022. Chronic skin diseases have every right to have the same dignity as other diseases, also in terms of attention in the reference programming plans, such as the one for chronic conditions. We need more accurate data, which can only be obtained through greater awareness of the impact that these diseases have on people and on the NHS.”
Psoriasis – it was reiterated in the meeting – affects one in 10 people in Italy with chronicity or multi-chronicity (1.8 million out of 24 million). It affects approximately 3% of the population with important consequences on the quality of life and social relationships. The annual costs per patient in Italy, considering those supported by the NHS and those out of pocket, are 11,434 euros (International Federation of Psoriasis Associations). Another pathology is vitiligo, which affects 1% of the world’s population, so far not recognized in the Lea and too often still considered only a mere aesthetic defect of spots on the skin. In reality, 15.3% of patients – the experts emphasized – have one or more autoimmune conditions: rheumatoid arthritis has a frequency greater than 100% in these patients; lymphomas have an incidence four times greater; lupus five times greater. The most common autoimmune disease, present in more than one in ten cases of vitiligo sufferers, is hypothyroidism, with an incidence about 75% higher than the national average. And those affected are 5 times more likely to develop depression.
According to the data on intramoenia activity published by Agenas – it was highlighted during ‘Equity Group – Chronic skin diseases’ – in 2022 accessing a dermatological visit was more complicated than in 2019 and even compared to the full pandemic period: the services available to patients for the purposes of a diagnosis or check-ups in the four annual surveys were 5154 (the other years there were 3 surveys, ed.) against approximately 11,000 in the previous three-year period, over half less than in the previous 3 years. An alert that should not be overlooked comes from the lack of attention in national planning, starting with the new National Chronicity Plan which in the most recent draft left them out of the second part: the result is the absence of regional Pdtas and a few company Pdtas (mainly hospital/university) on widespread diseases such as psoriasis, vitiligo, etc.
There are also positive signs: Parliament and Regions – according to experts – are demonstrating political sensitivity towards skin diseases: motions, agendas, resolutions have been approved, but they must be translated into binding acts to ensure greater equity for people with chronic skin diseases. For this reason Salutequità – Italian laboratory for analysis, innovation and change in health and social policies – has outlined some fundamental steps: 1. accessibility, timeliness and appropriateness in accessing services for a multidimensional care, capable of preventing complications and promoting adherence thanks to psychological support and telemedicine; 2. protections and ability to keep up with the times of the Lea; 3. simplification and organizational efficiency. “It is necessary not only to update the Lea – Aceti points out – to introduce pathologies and services essential for a treatment in step with the times, but also to have certain times for their implementation. Those of 2017 are still at a standstill”.
To overcome the difficulties in access, the Regions have implemented various initiatives. The Salutequità Observatory has noted that, for example, Veneto has activated a public notice for the assignment of individual assignments for specialists in dermatology and venereology, setting, in derogation from the ordinary tariff regimes, an hourly remuneration of up to a maximum of 100 euros gross all-inclusive for medical personnel, up to 60 euros for health sector personnel and 40 euros for specialists.
Puglia, on the other hand, has focused on the establishment of the regional dermatological network and the regional technical table in dermatology to rationalize and implement healthcare, networking the hospital and the territory; define Pdta and indicators to measure volumes, quality and outcomes; support a communication plan on skin diseases. Currently it seems to have a setback.
The regional councils of Lombardy, Abruzzo, Lazio, Liguria, have promoted initiatives to activate regional dermatological networks, recognize pathologies such as vitiligo in the Lea and improve the care of people with psoriasis. Various measures to promote appropriate prescriptions in Piedmont, Calabria, Sicily, Veneto, Emilia Romagna. Sicily has established a regional technical table for psoriasis and refers in the Territorial Assistance Network Plan, to dermatology as an area on which to work in regional networks and Pdta.
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