ROME (ITALPRESS) – Personalized examinations, diagnosis and treatment for every patient over 65 years of age: this is the goal as of this year possible thanks to the National Guidelines on Multidimensional Assessment (VMD), published last year on the National Guideline System of the Istituto Superiore di Sanità after work promoted by the Italian Society of General Medicine and Primary Care (SIMG) and the Italian Society of Hospital and Territorial Geriatrics (SIGOT), with the methodological support of the Istituto Superiore di Sanità (ISS) and the contribution of 25 other scientific societies. A few months later, a new paradigm of taking care of the elderly patient is emerging.Precisely at the SIMG Congress under way in Florence, a talk show entitled “The mosaic of complexity: innovative solutions through Multidimensional Assessment” was held, the new paradigm of taking care of the elderly patient, under the banner of a comprehensive analysis of clinical, psychological and social aspects to define diagnostic and therapeutic paths.The Guidelines on Multidimensional Assessment offer a novel perspective with which to frame the patient over 65 years old.”To address the clinical picture, one cannot help but consider other dimensions,” stresses Pierangelo Lora Aprile, SIMG Scientific Secretary. “Social aspects, such as loneliness or poverty, gain prominence, also of the initial signs of cognitive impairment, on which today we have diagnostic delays of up to 10 years; nutrition affects sarcopenia and the consequent risk of falls; sedentariness affects the prognostic fate of cardiovascular disease, diabetes and others. When frailty becomes very high, such as in the sick approaching the end of life, spiritual aspects, which are indispensable for coping with the last years of life, also become relevant. Therefore, we move from a medicine aimed at treating the disease to a holistic medicine aimed at the health of the whole person. “As SIMG we are integrating these tools into daily clinical practice,” explains Alberto Magni, head of SIMG Macroarea Fragility. The evolution will consist in automating the use of data that can already be obtained through the Primary Care Frailty Index, an indicator of frailty developed by SIMG, which can be integrated into software along with the tools offered by Multidimensional Assessment. Already there is a new model in the training paths of family physicians, to whom it is explained with special training modules how Multidimensional Assessment, through specific questions on the different domains, is an indispensable tool for care planning. With this approach, treatment is harmonized with the patient’s clinical, psychological, social and welfare pathway, with nutritional and vaccination aspects, as well as improving communication between health professionals, patient and caregiver. This training is aimed not only at General Practitioners, but also at nurses and other health care professionals. “The Guidelines represent a tool for the enhancement of the General Practitioner, who, in addition to being the figure closest to the patient, has always applied this holistic approach, but with this tool he can standardize the evaluation criteria and each clinician can define a scientifically certified personalized treatment plan,” highlights Alessandro Rossi, SIMG President. The General Practitioner, if put in the right conditions, can produce health, promoting active aging thanks also to a synergy with specialists. Preventing diseases or mitigating their symptoms with targeted interventions means avoiding emergency room admissions, hospitalizations, and risks of disability, thus also offering greater sustainability of the SSN. “SIMG has implemented various tools to promote stratification, Multidimensional Assessment, Care Planning, training and research. The Multidimensional Prognostic Index (MPI), recommended by the VMD Guidelines in Primary Care in order to reduce hospitalization rates, has its own simplified version (Brief-MPI) that correlates excellently with the tool from which it is derived. The scientific rigor with the ease of use and the short time required for its compilation can contribute to its rapid dissemination.Recent initiatives include the “Radar: comorbidity, frailty, multidimensional assessment, individual care plan” project, which identifies a training pathway in primary care to identify frail patients by stratifying the population according to various dimensions. The Radar project plans to implement the Multidimensional Assessment Guidelines in the decision-making processes of all family physicians. SIMG offers particularly motivated physicians a training course at the end of which they can take an exam, organized by the relevant Ministry, and obtain the qualification of General Practitioners Experts in Complexity Medicine. These physicians will be entrusted with four tasks: advising colleagues in the aggregations and AFTs; teaching complexity medicine in the Specific Training Course for GPs; governance of the pathways taken by patients from the moment of their identification to their taking over by the Networks; facilitation of relations with district specialists (geriatricians); and scientific research. The first round of training has already taken place, now new ones are about to start in order to multiply the number of GPs engaged in this process, with the aim of having at least one expert family doctor per 100,000 inhabitants.”Another novelty introduced by the guidelines is research, of which some projects are underway, such as Primacare, carried out with funding from the Ministry of Health by Ospedale Galliera, Istituto Superiore di Sanità, University of Palermo and University of Bari,” explains Alberto Magni. “Primacare research is currently in the follow up phase and will end in 2025. For this trial, some groups of SIMG physicians from four centers (Desenzano, Florence, Naples, Bari), subjected a population of patients over 65 to multidimensional assessment and biological sampling to understand the movements of some markers.”In line with its mission to enable people around the world to live healthier lives at every stage, Viatris Italia, a company of the Viatris Group, a global reality operating in the field of health, has always been at the side of the General Practitioner, as well as of all the actors of the health system, to allow access to high-quality medicines to more and more patients, regardless of place and context. “At Viatris we are committed every day to promote access to health for all people, looking at health care not as it is, but as it should be. We believe that the personalization of care will enable a more complete and effective management of the elderly patient, who is often frail and has a complex clinical picture. This is why we have decided to contribute to the dissemination of the Guidelines through the unconditional sponsorship of the Radar Project,” comments Fabio Torriglia, Country Manager of Viatris Italy. “It is precisely thanks to the joint work with all stakeholders in the health system, institutions, associations, scientific societies and individual professionals that we can have a concrete impact on public health and support the sustainability of the health system.
– Simg press office photo –
(ITALPRESS).
