IMPROVING HEALTH CARE ACCESSIBILITY FOR PEOPLE WITH COMPLEX DISABILITIES

For many people with disabilities in health care even the simplest actions such as performing an examination or a test can be extremely difficult, just as a hospitalization or an access to the emergency room can be complex experiences. The issue of acce ss to health services is felt to be particularly critical and unresolved by users, families and operators, who still report significa nt difficulties. The solutions to the problems of accessibility to care cannot be sought only at the clinical and professional lev el, but must rely on organizational and managerial innovations. The Seraphic Institute has promoted a project to ensure a better respon se to the health needs of people with complex disabilities to adapt the health care offer to the needs of people with disabilities , activating a proximity service aimed at reducing the inconvenience and costs related to the fragmentation of services and to im prove and extend access to care of people with complex disabilities through the activation of a regional reference pole and a network of specialized multicenter and multidisciplinary assistance (Hub & Spoke model

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

IMPROVING HEALTH CARE ACCESSIBILITY FOR PEOPLE WITH COMPLEX DISABILITIES

For many people with disabilities in health care even the simplest actions such as performing an examination or a test can be extremely difficult, just as a hospitalization or an access to the emergency room can be complex experiences. The issue of acce ss to health services is felt to be particularly critical and unresolved by users, families and operators, who still report significa nt difficulties. The solutions to the problems of accessibility to care cannot be sought only at the clinical and professional lev el, but must rely on organizational and managerial innovations. The Seraphic Institute has promoted a project to ensure a better respon se to the health needs of people with complex disabilities to adapt the health care offer to the needs of people with disabilities , activating a proximity service aimed at reducing the inconvenience and costs related to the fragmentation of services and to im prove and extend access to care of people with complex disabilities through the activation of a regional reference pole and a network of specialized multicenter and multidisciplinary assistance (Hub & Spoke model