“Non-communicable chronic-degenerative diseases are very important from a social and economic point of view. Chronic kidney disease, in patients with diabetes, hypertension or heart failure requires a multidisciplinary approach. These are patients who not only need a general practitioner, but a nephrologist, cardiologist, diabetologist.” Thus Loreto Gesualdo, president of the Federation of Italian medical-scientific societies (Fism), comments on the launch of the pilot project ‘Knowing and preserving heart, kidney and diabetes health’ (https://cuorerenidiabete.it) which offers free specialist consultations for patients diagnosed with cardiovascular, renal and metabolic pathologies at 3 general medicine clinics in Rome, Milan and Caserta. The initiative aims to raise awareness of the importance of monitoring one’s health, not only in the event of a confirmed diagnosis, but also to identify any latent conditions, to encourage a timely diagnosis.
The project – promoted by Aristea, with the patronage of Fism and the unconditional contribution of Astrazeneca – intends to facilitate the development of a territorial network, connecting general practitioners with specialists (cardiologists, diabetologists and nephrologists) to improve care and optimize the treatment paths. This initiative “is part of – explains Gesualdo – part of a broader activity of the Fism which aims” at a “multidisciplinarity approach with a single prescription. We have seen how complex the journey of the patient with comorbid chronic kidney disease is – that is, the diabetic patient , hypertensive, with heart failure – who is forced to see more specialists and acquire more prescriptions which then puts the general practitioner faced with the choice of which therapy to set and how to set it.”
Chronic kidney disease “is very frequent, affecting 10% of the world’s population, more than 850 million people”. It occurs in a comorbid patient because the causes are found more frequently “in diabetes, hypertension, in inflammatory diseases such as glomerulonephritis and in genetic pathologies such as polycystic disease”. But above all – continues the Fism president – in cardiac causes metabolic and hypertensive conditions, in particular hypertension, diabetes and heart failure”. Early diagnosis of chronic kidney disease is important to “avoid progression towards terminal renal failure, which is represented by dialysis and transplantation. But we must not forget – he warns – that the comorbid patient, the patient with chronic kidney disease, diabetes and hypertension, is also a patient with a high cardiovascular risk”.
The importance of the multidisciplinary approach is linked to the direct and indirect costs these patients incur. Direct costs are those linked to the patient’s need to “go to the general practitioner – explains Gesualdo – and then turn to other specialists such as the diabetologist and the cardiologist who need to review the clinical case and change and vary the approach therapeutic. Indirect costs, on the other hand, are linked to the advanced age of the patient who more often than not needs a caregiver” who must “abstain from the workplace to accompany their loved one in the multidisciplinary care process. And here is therefore the importance of teaming up – he highlights – the essential need to develop new diagnostic-therapeutic paths that can take the multidisciplinary patient by the hand and make him go towards the so-called patient journey, the treatment journey of the patient suffering from kidney disease chronic with multicomorbidity. The secret dream is to try to create a single path with a single prescription, have the patient in the presence of the general practitioner or the nephrologist or the cardiologist or the diabetologist and share on a digitalized platform the clinical-therapeutic-assistance path to which that particular comorbid patient will encounter.”
In this regard, “Fism has launched a multidisciplinary project with a single prescription – underlines Gesualdo – a project that is based on a digitalisation platform that sees the patient at the center of attention. What we want to do is try to create a strong link, a strong collaboration between the general practitioner, the nephrologist and with all the other specialists. “The pilot study – concludes the Fism president – is a feasibility study which will however find development in the patient journey, from multidisciplinarity to a single prescription, which at the moment is not priced in Italy”.
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