Therapeutic innovation in high-prevalence chronic diseases: Challenges and opportunities for specialist care models

Abstract

Therapeutic innovation is expected to change if not disrupt present care models for several chronic diseases in the coming years, as suggested by recent clinical trials. New drugs that anticipate and possibly delay the full expression of a disease will likely face some common challenges, such as the need of designing and implementing large scale interventions; the necessary engagement of multiple specialties for both diagnosis and treatment; the shift from specialist to non-specialist interventions and secondary prevention. Building on the case of HCV and other innovation in hepatology, we discuss common challenges caused by disruptive change that other chronic conditions faced in the past. The recent history of hepatology shows interesting examples of disruptive innovations that completely reverted traditional treatment approaches. As we learned from the slow early diffusion of antiviral drugs, without a clear information and a prompt design of the appropriate delivery modalities, the effectiveness of new treatments is undermined and care risk to be postponed for long time. This implies the definition of (i) new service models diversified by care phases and patients’ target; (ii) horizontal integration: to go beyond the professional boundaries to build solid alliances; (iii) vertical integration between primary and secondary care.

Investigating the Determinants of Beds for High-Care Specialties in the Italian Regions in the Environmental, Social and Governance Model

“…Waiting lists and the lack of organizational efficiency at healthcare management level limit patients' access to care, as in the case of migraine treatment [16]. The technological and organizational innovations introduced at a therapeutic level have made it possible to modify the assistance and treatment systems, moving from interventions by specialists to interventions by non-specialists also thanks to secondary prevention [17]. The use of risk-based healthcare systems could increase the ability to distinguish patients between primary and secondary care while also managing to identify patients who require more specialized care, as in the case of nephrology in the UK [18].…”