Abstract
Methods for the provision of supplementary healthcare: a survey in different regional contexts in Italy. Introduction. Supplementary healthcare is an essential service for patients suffering from chronic diseases. It is included within the "Livelli Essenziali di Assistenza" (LEA), "Decreto del Presidente del Consiglio dei Ministri" (DPCM) 12th January 2017, and therefore it is provided freely to patients (Regional Health Services are in charge to define the organizational methods to provide it). The goal of this multicentric study is to collect information on a national level on the aforementioned topic in order to highlight any critical issue and system correction. Materials and methods. A scientific area of "Società Italiana di Farmacia Ospedaliera" (SIFO) has developed a survey validated by the SIFO working group and by researchers of the "Libero Istituto Universitario Carlo Cattaneo" (LIUC) Business School. The investigated products of supplementary healthcare considered in the analysis are: Disposable Medical Devices (DMM: ostomies, dressings for skin lesions and devices for fecal incontinence), devices for diabetics (DpD), foods for nephropathy (AN) and thickening preparations for dysphagia (AP). The questionnaire was addressed to pharmaceutical services, refers to data related to 2018 and it is divided into different sections: organizational models of provision and purchase, epidemiological data and economic data. Twenty-five pharmaceutical services were recruited, 12 participated actively. The study is still ongoing; however, preliminary results are presented. Results. Regarding the inclusion of additional products to be provided within the LEA, around 60% of the recruited centers responded favorably regarding DMM, 75% for AN and 82% for AP. Direct Distribution is the main delivery channel: in about 60% of cases for ostomy and dressings for skin lesions, 100% for fecal incontinence devices, and 42% and 82% for AN and AP, respectively. The distribution of DpDs is performed through accredited pharmacies in 70% of the centers involved, with different modalities. In about 90% of cases, the purchase method chosen is direct purchase with the exception of DpD, AN and AP. Epidemiological data regarding the prevalence, per capita consumption and expenditure of disposable ostomy devices shows the highest prevalence recorded in Campania, followed by Emilia-Romagna and Puglia, while the lowest prevalence was registered in Apulia, followed by Veneto and Lombardy. As regards to economic data, the highest per capita expenditure was recorded in Lombardy, followed by Apulia and Liguria, while the highest per capita consumption was recorded in Apulia. Discussion. Data collected are homogeneous as regards to the reception of annex 2 of the Prime Ministery Decree of 12th January 2017, and also concerning additional services, methods of supply and purchase, while data reports variations according to the category with regard the type of purchased product. On the other hand, data related to prevalence, expenditure and per capita consumptions are variable based on the context. Conclusions. The fragmentation of the governance of the National Health Service and the interregional management variability could generate discrepancies between the different regional contexts. Despite a lack of information on products for supplementary healthcare, the information processed showed homogeneous data and the continuation of the study will give further hints and comparison tools.