Innovatori, indecisi, bisognosi o autonomi. I medici di medicina generale tra integrazione e accountability

Abstract

L’assistenza primaria in Italia sta subendo una radicale riforma con l’introduzione delle Aggregazioni Funzionali Territoriali (AFT), ovvero gruppi obbligatori di medici di medicina generale che si associano per rispondere insieme sia ai bisogni della popolazione assistita, sia per implementare le logiche del governo clinico. La Toscana già a partire del 2014 è stata una delle prime Regioni a formalizzare le AFT negli Accordi Regionali e Aziendali e a nominare i coordinatori di AFT, ovvero medici di medicina generale che hanno il compito di guidare l’AFT nella programmazione e revisione di obiettivi di governo. A partire da un questionario rivolto ai coordinatori di AFT toscani, gli autori hanno analizzato la percezione dei coordinatori rispetto all’innovazione rappresentata dalla AFT, sia in termini di fiducia verso la logica di integrazione monoprofessionale (fiducia verso l’organizzazione), sia in termini di difficoltà percepita rispetto all’assolvimento del proprio incarico (fiducia verso il ruolo). Sulla base di tali criteri, gli autori hanno delineato, per il contesto della Toscana, 4 differenti gruppi di coordinatori con percezioni simili verso l’innovazione manageriale e organizzativa della medicina generale

Is the co-location of GPs in primary care centres associated with a higher patient satisfaction? Evidence from a population survey in Italy

“…Moreover, the FAGs aim to promote the coordination and continuity of care, to facilitate the homogenous definition and implementation of care pathway for chronic patients, to favourite the dissemination of primary care best practices, by using the typical tools of clinical governance, such as audit, peer review, monitoring activities. In Tuscany, all GPs joined one of the 115 FAGs, with an average of 25 GPs per FAG, which then serve a population of around 30,000 patients [50, 51]. …”

Trade union or trait d'union? Setting targets for general practitioners: A regional case study

“…We define as "managerial tools" the mix of systems, procedures, and roles that make GPs accountable regarding their choices, mainly consisting in pay for performance or incentive systems. 13,14 This study aims at inquiring the relationship between the managerial tools adopted by the local health authorities (LHAs) in the Tuscany Region (Italy) and the attitude of the health care professionals toward these very same tools. In particular, the organizational framework that our research explores is represented by the introduction of managerial mechanisms through the implementation of new associative forms among general practitioners.…”

“…In particular, the organizational framework that our research explores is represented by the introduction of managerial mechanisms through the implementation of new associative forms among general practitioners. Teams-in our case, the "Aggregazioni Funzionali Territoriali" (AFTs), as described in the next section-represent a potentially powerful lever for change 14 as they are the basic building blocks of microsystems. There is evidence that effectively functioning teams or microsystems are generally associated with higher quality of care but the challenge consists in developing effective teams.…”

“…Obstacles to the smooth functioning of primary health care teams include interpersonal and professional issues such as role conflicts, professional boundary disputes, value differences, and tensions concerning power, autonomy and control. 14,23 Targets negotiation and discussion capacity (3) The achievement of a goal is moderated and mediated by other variables. 24 Some of these variables refer to the psychological or individual sphere, such as ability (people should know and have the skills to obtain a specific performance) and self-efficacy (the believed capacity to perform certain levels of tasks); other factors relate to the organizational or group sphere, such as the commitment demonstrated by supervisors and peers and the feedback mechanisms.…”

“…A key priority in Italy is to achieve better coordination of services across the continuum of care, to improve quality and curb health care costs. To this end, the recent health planning legislation 34,35 focuses on the organization of primary care services, by promoting monoprofessional organizations, known as "Aggregazioni Funzionali Territoriali" (AFT) 14 (Barsanti et al 2016). AFTs represent the highest and unique level of GPs' association; each of them serves a population of about 30 000 patients, assisted by 25 GPs.…”