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.
Chronic heart failure CHF or simply HF is a complex clinical syndrome that involves more than % of the general population and over % of the older people. For people with reduced ventricular function the classical HFrEF phenotype , the guidelinedirected medical therapy GDMT e.g., Ace-inhibitors, beta-blockers, diuretics, rehabilitation or implantable ventricular devices demonstrated to be efficacious in reducing hospitalisations and prolonging survival. Vice-versa, the HF with preserved ejection fraction diastolic HF or HFpEF phenotype is a much more complex syndrome, in which co-morbidities such as COPD, depression, anemia, and diabetes, CAD play a significant role in the decompensation episodes.As the population ages, the HFpEF phenotype is becoming more frequent and puts more management problems, since the conventional HF therapy is less efficacious in the control of symptoms. A multidisciplinary managed approach, based on the principles of Chronic Care Model, is the most effective tool to ensure best clinical and social outcomes, for both phenotypes. It is critical that every health worker should use counselling tools, such as how to recognise characteristics of the disease or early signs of decompensation and whereby to manage them, the proper use of each drug or how to modify progressing risk factor, to improve the compliance of the patients toward the self-management empowerment.Finally, we propose a plan of care for patients affected with HF, which allows the integration of multidisciplinary teams and ensures a complete and appropriate management of the cases, in respect of therapeutic responsibility entrusted to the GP.
Several studies suggest that the cardiovascular disease CVD mortality rates of persons with type diabetes are about two to four times higher than those of the general population. It is therefore considered necessary to develop specific tools to evaluate and reduce CVD risk in this population. In the present chapter, main CVD risk scores were explored from the Framingham study developed in the s to the last diabetes-specific models, passing through the concept of diabetes as a CVD risk equivalent . The scores developed in Italian population were specifically explored. The Italian experience, according to other countries, emphasizes that it may be appropriate for each country to validate existing models and eventually to adapt them to the different settings to improve targeted risk management.
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).
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