|Tipo di tesi||Tesi di laurea magistrale|
|Titolo||percorso diagnostico terapeutico assistenziale (PDTA)nello scompenso cardiaco:dialogo ospedale-territorio, una realtà possibile?|
|Titolo in inglese||The diagnostic and therapeutic care pathways (PDTA) in heart failure: the dialogue between hospitals and community - a possible reality?|
|Struttura||Dipartimento di Medicina Diagnostica, clinica e di sanita' pubblica|
|Corso di studi||SCIENZE INFERMIERISTICHE E OSTETRICHE (D.M. 270/04)|
|Data inizio appello||2015-11-16|
|Disponibilità||Accessibile via web (tutti i file della tesi sono accessibili)|
BACKGROUND: I sistemi sanitari sono sempre più orientati ad affrontare la cronicità attraverso la medicina di iniziativa (promozione della salute, identificazione e classificazione dei pazienti fragili, alto e molto alto rischio di ospedalizzazione, interventi mirati nel territorio per ridurre ospedalizzazione ed ottimizzare efficienza SSN, disegno ed organizzazione di percorsi di case/care/disease managment gestione e monitoraggio attivo pazienti). Le Linee Guida sullo scompenso cardiaco cronico (SCC) della Società Europea di Cardiologia raccomandano un sistema organizzato di cura specialistica dei pazienti con SCC in quanto migliora i sintomi e riduce le ospedalizzazioni e la mortalità .
BACKGROUND: Health care systems are increasingly oriented to face chronic diseases/ chronicity towards proactive medicine (health promotion, identification and classification of frail patients, high and very high risk of hospitalization, regional targeted interventions to reduce hospitalization and improve the National Health Service (NHS) efficiency, design and organization of individual case / care / disease management and active monitoring of patients). Guidelines on Chronic Heart Failure (CHF) of the European Society of Cardiology suggest the creation of an organized system of care for patients with CHF as it may help reduce the symptoms, hospitalizations and mortality. In 2011 Emilia Romagna has introduced a regional protocol for heart failure and has released it throughout the region by implementing different Community Healthcare Centers (CHC) and / or Primary Care Center. The region has tried to promote the access to appropriate health care services to user from all regional contexts, to implement the collaboration between general practitioners (GPs) and local hospitals. METHOD: We tried to assess the state of the art within the AUSL Romagna – Forlì district, according to available scientific evidence concerning the implementation of specific professionals. The aim is to encourage good care practices, optimizing facilities and the available resources, promoting dialogue between hospitals and community heath structures. OBJECTIVES: We sought to: 1) describe the territorial organization following the regional protocol of the diagnostic-therapeutic-care (PDTA) of patients with chronic heart failure (CHF); 2) assess the level of implementation of regional guidelines; 3) identify any critical issue and draw up an organizational proposal to optimize the path itself. CONCLUSION: The implementation of professionals (care managers) may facilitate the dialogue between the hospital and the community, reducing user’ inappropriate access to health structures and optimizing the available resources. Our model of care for patients with CHF can guarantee continuity of care for patients in the phases of clinical stability and frequent exacerbations. The model is a multidisciplinary and multi-professional network, with centers dedicated to hospitalization ( outpatient clinics for chronic cardiopathic patients and / or CHF). Moreover, PDTA are shared between the hospital and the community. In the literature the effectiveness of PDTA is demonstrated in patients’ improved outcome. In the context of primary care, Romagna Ausl- Forlì district, introduced the figure of the dedicated nurse as a facilitator of PDTA, and it will be useful to measure the impact of this introduction through patient’s satisfaction and optimization of health care system’s resources.