Experimenting clinical pathways in general practice: a focus group investigation with Italian General Practitioners

Background. Clinical governance is considered crucial in primary care. Since 2005, clinical pathways have been experimentally implemented at the Local Health Authority of Monza Brianza (ASLMB), Italy, to develop general practitioners\u2019 (GPs) care of patients affected by some chronic diseases. The experimentation was aimed at introducing clinical governance in primary care, increasing GPs\u2019 involvement in the care of their patients, and improving both patients\u2019 and professionals\u2019 satisfaction. In the period 2005-2006, 12% of the 763 employed GPs in the ASLMB were involved in the experiment, while this percentage increased to 15-20% in 2007-2008. Design and Methods. Twenty-four GPs were purposively sampled, randomly divided into two groups and asked to participate in focus groups (FGs) held in 2008, aimed at evaluating their perception of the experiment. The FGs were audio-recorded, dialogues were typed out and undergone to a thematic analysis, according to the Interpretative Phenomenological Approach. Results. Four major themes emerged: i) clinical pathways can result in GPs working in a more efficient and effective fashion; ii) they can assure higher levels of both patient and professional satisfaction, since they sustain a caring approach and strengthen the GPs\u2019 role; iii) nevertheless, clinical pathways increase the bureaucratic workload and problems can arise in relationships among GPs and the LHA; iv) the implementation of clinical pathways can be improved, especially by reducing bureaucracy and by assuring their continuity. Conclusions. Managerial aspects should be considered with care in order to experimentally introduce clinical pathways in general practice, and continuity of the experimentation should be guaranteed to improve GPs\u2019 adherence and commitment

Breast cancer prevention in the ASL of Lecco : local guidelines for a mammographic screening program

Breast cancer is the first cause of mortality due to cancer in women, with an incidence rate in Lombardy of 80.6/ cases per 100.000 women every year. Screening through mammography in women aged 50 to 69 is widely believed to be effective in reducing mortality. In Italy few cities and regions are running organized screening programs, while the request for breast cancer prevention is increasing. For these reasons the Health Agency of Lecco (ASL Lecco) organized and developed a Breast Cancer Screening program as a Strategic issue in the years 1999-2001. The organization process started with the analysis of the breast cancer incidence and the frequency of "spontaneous screening" in the Province of Lecco. Afterward two work groups were established: an Operative Project Group with the aim of producing local guidelines and of preparing the operating plan; and a Technical Committee to validate the guidelines and to provide scientific and technical aid to the operative group. According to the guidelines, women aged between 50 and 69 are invited by letter every 2 years with a prearranged appointment that can be changed by phone. An Organisation and Evaluation Unit and a Breast Cancer Diagnostic Unit are activated