Simplification, clear temporality, strong monitoring, funding and integration with other pathologies to ensure equity and effectiveness. These are the 6 steps necessary for updating the new National Chronic Disease Plan (PNC) drawn up by the Ministry of Health, and for examination by the Regions, so that it is truly effective. The Salutequità Observatory highlights this in an analysis in which it explains how to ensure that the new plan for the 24 million Italians suffering from one or more chronic pathologies which account for around 80% of healthcare spending does not remain on paper: 70.7 billion euros in 2028, according to Istat projections.
In detail, we read on the Observatory website, reading and understanding should be facilitated with the creation of a single text on chronicity. The draft sent to the Regions was in fact not integrated with the 2016 plan and therefore obliges – to have a clear picture – the creation of an integrated text between the 2016 one and the one that could be launched in 2024. It is then necessary to ensure and define a temporality. All other plans have a start and end date, to offer the actors who must implement it, verify it, use it, to plan the application times and calibrate the expectations of professionals and citizens. The provision of a temporality also limits blackout situations in the event, for example, of delays in the renewal of the Control Room, in whose hands the updating and verification of the Plan is currently in the hands. Another point is to indicate and define the resources for implementation. While on the one hand the minister, in his policy document, underlines the importance of “investing strategic resources in national plans which constitute the systemic response to health issues relating to chronicity, rare diseases, … the prevention and fight against cancer ”, the lack of provision of resources for its implementation is not only inconsistent with the indications expressed, but risks the act remaining only on paper. It is difficult for implementation to take place without dedicated resources for the expected objectives and the inclusion of new pathologies (e.g. for the technological adaptation of diagnostic devices, the recognition of an exemption code for obesity – currently not included in the Lea, for clinical networks with skills and adequate diffusion, etc.).
Again according to Salutequità, it is necessary to provide a stringent monitoring system that dialogues with the Essential Levels of Assistance (Lea) monitoring. The monitoring described in the Plan is weak. If on the one hand it indicates that there are 3 guidelines (regulatory monitoring, organized and operational structures, health indicators of individual chronic pathologies) on the other it also clarifies that the monitoring function will be able to provide useful elements to calibrate regional/provincial strategic choices and local’ but does not refer to the consequences of a possible non-application of the PNC.
The verification only affects the Pdta (diagnostic therapeutic care pathways) of the pathologies included in the Plan and leaves out many other chronic diseases, therefore without an overall governance vision of chronicity. Finally, the monitoring model does not communicate with the LEA compliance system. Another point highlights that there must be clear transparency and publication of the report on the progress of the PNC implementation. On the one hand, a step forward has been taken by indicating that Agenas (National Agency for Health Services) technically supports the Control Room in monitoring. On the other hand, however, it is not specified whether the annual report on the results of the monitoring activities – normally prepared by January of the following year – will be made public to ensure accountability of the interventions and the results produced.
Finally, according to the Observatory, it is necessary to integrate the PNC with groups of chronic pathologies that require specific attention that can no longer be postponed. This is the case, for example, of psoriasis which affects 1.8 million people in Italy and which remains an underestimated pathology, often associated with pathologies already included in the second part of the 2016 Plan, but which is so underestimated that it is not even detected by Istat nor in those of the Passi surveillance system (Progress of health companies for health in Italy). And it still lacks attention to ‘new chronicities’. The draft PNC sent to the Regions lacks a reference to the ‘new chronic conditions’ which characterize, for example, some hematological neoplasms for which the scientific goals achieved thanks to research have radically changed the treatment paths and life expectancy. This is the case of neoplasms such as chronic lymphocytic leukemia or chronic myelogenous leukemia in which the concept of chronicity is already explicitly expressed in the ‘name of the pathology’.
“If approved in this version – comments Tonino Aceti, president of Salutequità – the update of the PNC risks remaining only the plan of ‘good intentions’, destined to remain on paper like the previous one whose errors it repeats. Starting from the absence of dedicated resources, of a certain time horizon, of an integration with other pathologies that require specific and no longer postponable attention and of a timetable that dictates the rhythm of the obligations and of an effective verification mechanism that dialogues with the Lea compliance system. The hope is – he concludes – that the Regions, together with the ministry, already from the meetings scheduled in the next few days, will follow this path, thus closing a truly and finally effective document”.
#Salutequità #missing #guarantee #effectiveness #national #chronicity #plan
