Salute e sistemi sanitari orientati al territorio

1. Salute e sistemi sanitari orientati al territorio Gavino Maciocco Dipartimento di Sanità Pubblica Università di Firenze XXIII Congresso Nazionale CSeRMEG Costermano del Garda 29 ottobre 2011

2. While the global diseaseburdenhasbeenshiftingtowardschronicconditions, healthsystemshavenotevolvedtomeetthischangingdemand.Care isfragmented, focused on acute and emergentsymptoms, and oftenprovidedwithout the benefit of complete medical information.(WHO, 2003)

4. Distribuzione % delle cause di morte in Paesi con differenti livelli di reddito

5. Distribuzione % delle cause di morte in Paesi con differenti livelli di reddito

7. LA STORIA NATURALE DELLE MALATTIE CRONICHE

9. LA STORIA NATURALE DELLE MALATTIE CRONICHE SECONDO DUE DIFFERENTI SCENARI

10. SCENARIO DI MERCATO

12. BIG MACALLA SALSA DI STATINE ?

14. SIAMO A RISCHIO DI DIVENTARE A RISCHIO ? 4 September 2010

15. BMJ International classification of non-diseases (ICND) (N= 200)  Social fobia  Chronic fatigue syndrome  Seasonal affective disorders  Unhappiness  Anxiety about penis size  Loneliness  Tennis elbow  Chinese restaurant syndr.  etc., etc. Baldness  Irritable bowel syndrome  Osteoporosis  Menopause  Cellulite  Testosterone deficiency  Ageing  Pregnancy  Erectile dysfunction 15 Source: BMJ 13.04.02

16. “ SI PUÒ FARE UN SACCO DI SOLDI SE SI ARRIVA A CONVINCERE I SANI CHE IN REALTÀ SONO DEGLI AMMALATI” R. Moynihanet al. BMJ 2002 BMJ 13,April 2002 Too Much Medicine?

18. USA Europa Malattie cardiache 21,8 11,4 Diabete 16,4 10,9 Obesità 33,1 17,1 Cancro 12,2 5,4

20. SCENARIO DI sanità pubblica

21. Promozione della salute

22. La salute in tutte le politiche

23. E’ cruciale che gli individui si assumano la loro responsabilità nei confronti della loro salute cardiovascolare, ma è necessario che i politici affrontino seriamente la questione delle diseguaglianze nella salute e riducano il potere dellelobbiesdelle industrie del cibo e del tabacco che hanno l’interesse a perpetuare lo status quo.

24. Sanità d’iniziativa Promozione della salute

25. Livello 3 Pazienti molto complessi CASE MANAGEMENT Livello 2 Pazienti a alto rischio DISEASE MANAGEMENT 70-80% dei pazienti Livello 1 Con il giusto supporto le persone possono imparare a essere attivi protagonisti della loro condizione PROMOZIONE DELLA SALUTE

27. DENMARK FRANCE GERMANY THE NETHERLANDS SWEDEN UNITED KINGDOM AUSTRALIA CANADA

28. The overall aim that we set ourselves in this book was to compile an in-depth assessment of the health system response to the rising burden of chronic disease in each of the eight countries, by focusing on three key areas: • (1) a detailed examination of the current situation; • (2) a description of the policy framework and future scenarios; and • (3) evaluation and lessons learnt, building on a common template developed by the editors.

29. The template was informed, to great extent, by the Chronic Care Model (CCM) developed by Wagner and colleagues in Seattle. • This model presents a structure for organizing health care; it comprises four interacting components that are considered key to providing high-quality care for those with chronic health problems: • self-management support, • delivery system design, • decision support, and • clinical information systems.

30. DENMARK FRANCE GERMANY THE NETHERLANDS SWEDEN UNITED KINGDOM AUSTRALIA CANADA

32. THE CHRONIC CARE MODEL

34. Barbara Starfield

35. Person-focused care • Person-focused care over time makes it possible to identify, early in life, those conditions that are likely to influence subsequent ill health and, therefore, to attempt to reduce their impact. • It also provides the continuity of attention that is important in reducing the impact of chronic illnesses and reducing the likelihood of the progression to more serious illness and to more multimorbidity.

36. We need guidelines that are appropriate to person-focused care, not disease-focused care. Only primary care physicians can understand this, because they do not focus on particular organ systems and because they experience these realities every day in their practices. • Primary care physicians will have to continue to advocate for primary care-oriented health systems, because it is the only hope for achieving greater equity through appropriate medical interventions.