Esempi di organizzazione dei PDTA in alcune realtà: l'esperienza della Regione Puglia

Il lavoro è un contributo metodologico mutuato dall'esperienza della disciplina dell'economia aziendale nel campo dell'applicazione sanitaria dell'azienda pubblica

Analisi di Budget Impact dei farmaci biologici per la Dermatite Atopica – Il caso della Regione Puglia

È stata condotta un’analisi di Budget Impact con l’ausilio di un modello costruito secondo le linee guida metodologiche pubblicate dall’International Society for Pharmacoeconomics and Outcomes Research (ISPOR). La prospettiva adottata è stata quella del SSR pugliese, considerando un orizzonte temporale di analisi di 3 anni. Il modello ha preso in considerazione gli anticorpi monoclonali approvati e rimborsati in Italia per la dermatite atopica grave in pazienti adulti eleggibili al trattamento, dupilumab e tralokinumab. Sono stati confrontati i costi farmaceutici complessivi nella popolazione target in due differenti scenari: con e senza tralokinumab, stimando per quest’ultimo quote crescenti di impiego nel triennio

The effects of the introduction of a chronic care model-based program on utilization of healthcare resources: the results of the Puglia care program

Abstract Background Ageing is continuously increasing the prevalence of patients with chronic conditions, putting pressure on the sustainability of Healthcare Systems. Chronic Care Models (CCM) have been used to address the needs of frail people in the continuum of care, testifying to an improvement in health outcomes and more efficient access to healthcare services. The impact of CCM deployment has already been experienced in a selected cohort of patients affected by specific chronic illnesses. We have investigated its effects in a heterogeneous frail cohort included in a regional CCM-based program. Methods a retrospective population-based cohort study was carried out involving a non-oncological cohort of adult subjects with chronic diseases included in the CCM-oriented program (Puglia Care). Individuals in usual care with comparable demographic and clinical characteristics were selected for matched pair analysis. Study cohorts were defined by using a record linkage analysis of administrative databases and electronic medical records, including data on the adult population in the 6 local area health authorities of Puglia in Italy (approximately 2 million people). The effects of Puglia Care on the utilizations of healthcare resources were evaluated both in a before-after and in a case-control analysis. Results There were 1074 subjects included in Puglia Care and 2126 matched controls. In before-after analysis of the Puglia Care cohort, 240 unplanned hospitalizations occurred in the pre-inclusion period, while 239 were registered during follow-up. The incidence of unplanned hospitalization was 10.3 per 100 person/year (95% CI, 9.1–11.7) during follow-up and 12.1 per 100 person/year (95% CI, 10.7–13.8) in the pre-inclusion period (IRR, 0.84; 95% CI, 0.80–0.99). During follow-up a significant reduction in costs related to unplanned hospitalizations (IRR, 0.92; 95% CI, 0.91–0.92) was registered, while costs related to drugs (IRR, 1.14; p < 0.01), out-patient specialist visits (IRR, 1.19; p < 0.01), and planned hospitalization (IRR 1.03; p < 0.01) increased significantly. These modifications can be related to the aging of the population and modifications to healthcare delivery; for this reason, a case-control analysis was performed. The results testify to a significantly lower number (IRR, 0.79; 95% CI, 0.68–0.91), length of hospital stay (IRR, 0.80; 95% CI, 0.76–0.84), and costs related to unplanned hospitalizations (IRR, 0.80; 95% CI, 0.80–0.80) during follow-up in the intervention group. However, there was a higher increase in costs of hospitalizations, drugs and out-patients specialist visits during follow-up in Puglia Care when compared with patients in usual care. Conclusion In a population-based cohort, inclusion of chronic patients in a CCM-based program was significantly associated with a lower recourse to unplanned hospital admissions when compared with patients in usual care with comparable clinical and demographic characteristics

Additional file 2: of The effects of the introduction of a chronic care model-based program on utilization of healthcare resources: the results of the Puglia care program

Table S1. Number, mean(std) and median(range) of end-points in pre-inclusion and follow-up. (DOCX 16 kb

Additional file 1: of The effects of the introduction of a chronic care model-based program on utilization of healthcare resources: the results of the Puglia care program

Puglia_care.txt (database). (TXT 558 kb

Adherence to GOLD guidelines in real-life COPD management in the Puglia region of Italy

Background: COPD is a disease associated with significant economic burden. It was reported that Global initiative for chronic Obstructive Lung Disease (GOLD) guideline-oriented pharmacotherapy improves airflow limitation and reduces health care costs. However, several studies showed a significant dissociation between international recommendations and clinicians' practices. The consequent reduced diagnostic and therapeutic inappropriateness has proved to be associated with an increase in costs and a waste of economic resources in the health sector. The aim of the study was to evaluate COPD management in the Puglia region. The study was performed in collaboration with the pulmonology centers and the Regional Health Agency (AReS Puglia).Methods: An IT platform allowed the pulmonologists to enter data via the Internet. All COPD patients who visited a pneumological outpatient clinic for the first time or for regular follow-ups or were admitted to a pneumological department for an exacerbation were considered eligible for the study. COPD's diagnosis was confirmed by a pulmonologist at the moment of the visit. The project lasted 18 months and involved 17 centers located in the Puglia region.Results: Six hundred ninety-three patients were enrolled, evenly distributed throughout the region. The mean age was 71 +/- 9 years, and 85% of them were males. Approximately 23% were current smokers, 63% former smokers and 13.5% never smokers. The mean post-bronchodilator forced expiratory volume in 1 second was 59%+/- 20% predicted. The platform allowed the classification o f patients according to the GOLD guidelines (Group A: 20.6%, Group B: 32.3%, Group C: 5.9% and Group D: 39.2%), assessed the presence and severity of exacerbations (20% of the patients had an exacerbation defined as mild [13%], moderate [37%] and severe [49%]) and evaluated the appropriateness of inhalation therapy at the time of the visit. Forty-nine percent of Group A patients were following inappropriate therapy; in Group B, 45.8% were following a therapy in contrast with the guidelines. Among Group C patients, 41.46% resulted in triple combination therapy, while -14% of Group D patients did not have a therapy or were following an inappropriate therapy. In conclusion, 30% of all patients evaluated had been following an inadequate therapy. Subsequently, an online survey was developed to inquire about the reasons for the results obtained. In particular, we investigated the reasons why 30% of our population did not follow the therapy suggested by the GOLD guidelines: 1) why was there an excessive use of inhaled corticosteroids, 2) why a significantly high percentage was inappropriately treated with triple therapy and 3) why a consistent percentage (11%) of Group D patients were not treated at all.Conclusion: The data provides an overview on the management of COPD in the region of Puglia (Italy) and represents a resource in order to improve appropriateness and reduce the waste of health resources