High-quality in-home primary healthcare services are pivotal for people with dementia and their families to avoid inappropriate hospital admissions and premature nursing home placement, which are associated with worsened quality of life of both the person with dementia and his family and financial burden. This chapter gives a qualitative overview of the evidence on the efficacy and effectiveness of different primary care models covering all the stages of the disease from the onset of the disease until the more advanced stages with a particular focus on the management of behaviour and psychological disorders. A detailed description is provided of the primary care model of the Province of Modena for people with dementia and their families in which the general practitioner plays a central role both in the diagnostic process and in follow-up and closely collaborates with first-and second-level healthcare professionals. This "collaborative care" network is able to address timely the continuously changing needs of these frail people and their caregivers, including acute severe behavioural and psychological disorders. A 10-item composite indicator of appropriateness of care by the general practitioner has been recently introduced to further improve the quality of care within primary care.
Background Most symptomatic SARS-CoV-2 infections produce mild to moderate symptoms. Although most patients are managed in the outpatient setting, little is known about the effect of general practitioners’ (GP) management strategies on the outcomes of COVID-19 outpatients in Italy. Objectives Describe the management of Italian GPs of SARS-CoV-2 infected adult patients and explore whether GP active care and monitoring are associated with reducing hospitalisation and death. Methods Retrospective observational study of SARS-CoV-2 infected adult outpatients managed by GPs in Modena (Italy) from March 2020 to April 2021. Information on management and monitoring strategies, patients’ socio-demographic characteristics, comorbidities, and outcomes (hospitalisation and death due to COVID-19) were retrieved through an electronic medical record review and analysed descriptively and through multiple logistic regression. Results Out of the 5340 patients from 46 GPs included in the study, 3014 (56%) received remote monitoring, and 840 (16%) had at least one home visit. More than 85% of severe or critical patients were actively monitored (73% daily) and 52% were visited at home. Changes over time in patients’ therapeutic management were observed in concordance with the guidelines’ release. Active daily remote monitoring and home visits were strongly associated with reduced hospitalisation rate (OR 0.52, 95% CI 0.33–0.80 and OR 0.50, 95% CI 0.33–0.78 respectively). Conclusion GPs effectively managed an increasing number of outpatients during the first waves of the pandemic. Active monitoring and home visits were associated with reduced hospitalisation in COVID-19 outpatients.
Introduction:In the province of Modena an agreement between the Local Authority for Health (Azienda Sanitaria Locale, ASL) of Modena and the General Practioners (GPs) is in force since 2002. It consists of a protocol for integrated care of people with dementia (PWD) and their families between GPs and the Specialist centres for cognitive disorders, divided into two stages: 1) Taking charge of the patient by the GP (module A) ; 2) Follow-up care management, with annual reporting by the GP to the ASL by means of a pre-set paper module (module B) containing besides patients' demographic characteristics, clinical and therapeutic data. The objective of this project is to monitor the condition of both the patient and the family in order to promptly alert the social services and the network of integrated health and social services in the attempt to delay and/or prevent hospitalisations and/or inappropriate institutionalisation of PWD. Aim: To verify the appropriateness of the 2013 compilation of Modules B by GPs in the HealthDistrict of Mirandola relative to some variables considered important not only for more epidemiological reasons (prevalence of three levels of cognitive impairment: "mild cognitive impairment" [MCI]; "definite cognitive decline" [DCD]; "cognitive decline with depression" [CDDep+]), but also for the care solutions to be offered to the families on the basis of the progression of dementia (improved-stable-worsened) and the families' endurance in taking care for PWD at home (satisfactory-difficult-unmanageable).
Introduction: In the province of Modena an agreement between the Local Authority for Health of Modena and the General Practioners (GPs) is in force since 2002. It consists of a protocol for integrated care of people with dementia (PWD) and their families between GPs and the Specialist centres for cognitive disorders, divided into two stages: 1) Taking charge of the patient by the GPModule A; 2) Follow-up care management-Module B, containing besides patients' demographic characteristics, clinical and therapeutic data useful to monitor the incidence of complications considered notorious risk factors for hospitalisation and institutionalisation of PWD.
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