ROME (ITALPRESS) – National Plan Cronicity (PNC): in the update under consideration by the regions, six steps are needed for the document to be truly effective for the 24 million Italians suffering from one or more chronic conditions.On which about 80 percent of health care spending is spent. According to Istat projections, then, 70.7 billion euros will be spent on treating people with chronic conditions in 2028. Simplification, clear temporality, strong monitoring, funding and integration other diseases to ensure equity and effectiveness are the aspects to be improved in the document and the Salutequità Observatory in its analysis explains how to do it. It should be made easier to read and understand with a single text on chronicity. The draft sent to the regions is an update text, but it has not been integrated with the 2016 Plan and therefore obliges -to have the clear picture- the realization of an integrated text between the 2016 one and the one that could be launched in 2024.A temporality should be ensured and defined. All other plans have a start date and an end date to offer the actors who must implement it, verify it, and use it, to plan the timing of implementation and to calibrate the expectations of professionals and citizens. The provision of a timeline also limits blackout situations in case of, for example, delays in the renewal of the Steering Committee, in whose hands the updating and verification of the Plan is now in.Indicate and define resources for implementation. While the minister in his policy act stresses the importance of “investing strategic resources on national plans that constitute the systemic response to health issues concerning chronicity, rare diseases, … cancer prevention and contrast.”, the lack of provision of resources for its implementation is not only inconsistent with the indications expressed, but risks making the act remain only on paper. It is difficult for the implementation to take place without dedicated resources for the intended goals and the inclusion of new pathologies (e.g., for technological upgrading of diagnostic facilities, recognition of an exemption code for obesity-currently not included in the LEAs, for clinical networks with adequate expertise and outreach, etc.).Provide for a stringent monitoring system that dialogues with LEA monitoring. The monitoring described in the Plan appears weak. While it indicates that there are three strands (regulatory monitoring, organized and operational arrangements, health indicators of individual chronic diseases) it also clarifies that the function of monitoring “may provide useful elements to calibrate regional/provincial and local strategic choices” but does not call out the consequences of any inapplication of the Plan. The monitoring only affects the PDTAs (diagnostic therapeutic care pathways) of the diseases included in the Plan and leaves out many other chronic diseases, thus without an overall governance vision of chronicity. Finally, the monitoring model does not dialogue with the Lea fulfillment system.There must be clear transparency and publication of the PNC implementation progress report. On the one hand, a step forward has been taken by indicating that Agenas (National Agency for Health Services) technically supports the Steering Committee in monitoring. On the other, however, it is not specified whether the annual report on the outcomes of the monitoring activities-usually prepared by January of the following year-will be made public to ensure accountability of the interventions and outcomes produced.Supplementing the PNC with chronic disease groups that would require specific attention that can no longer be postponed. This is the case, for example, of psoriasis, from which 1.8 million people in Italy are affected 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 (Progress of Health Authorities for Health in Italy) surveillance system. And it still lacks attention to “new chronicities.” The draft PNC sent to the regions, lacks a reference to “new chronicities” that characterize, for example, some hematologic neoplasms for which scientific breakthroughs achieved through research have radically changed treatment pathways and life expectancy. This is the case of neoplasms such as chronic lymphatic leukemia or chronic myeloid 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 National Chronicity Plan risks remaining only the plan of ‘good intentions,’ destined to remain on paper like the previous one whose errors it repeats. Beginning with the absence of dedicated resources, a certain time horizon, integration with other pathologies that require specific attention that can no longer be postponed, and a timetable that dictates the pace of fulfillment and an effective verification mechanism that dialogues with the LEA fulfillment system. The hope is,” Aceti concludes, “that the regions, together with the ministry, already from the meetings scheduled in the coming days, will go down this road, thus closing a document that is truly and finally effective.
– photo: Ipa Agency -(ITALPRESS).
