The restart of post-COVID territorial medicine. The importance of scientific information on the drug

Webinar Assogenerici, Fimmg, Simg Monday 6 July 2020 / h. 11:00 – 12:30

The restart of territorial medicine after the Covid-19 emergency

The objectives shared between general practitioners and assogenerics for the reorganization of services, therapeutic continuity and the treatment of chronic conditions

During the Covid-19 emergency, many chronically ill patients suffered a slowdown in therapeutic continuity mainly due to the blocking of scheduled activities and the monopolization of hospital centers for the sole treatment of the coronavirus.

The general practitioners themselves - in the very early stages erroneously excluded from the management of the coronavirus emergency - concentrated a large part of their energies on the same front, paying a very high price in terms of lives lost, but still guaranteeing - during the lockdown period - the their total availability towards the assisted, working without hours and with guaranteed remote availability.

Similarly, companies engaged in the production of generic drugs have been at the forefront in responding to the treatment needs determined by the emergency, increasing production, transforming their production lines and activating their international network to cope with the exponential growth in demand of products (+200%) – almost exclusively generic – used for the management of patients in intensive care and home care.

In the current restart phase, while it is still necessary to maintain a high level of attention on the evolution of the epidemic wave, it is equally essential to plan the strengthening of the activity of taking charge of patients by the territory (also in home care) , investing energies and resources where the emergency has shown that there is room for improvement for assistance activities aimed in particular at prevention, monitoring and assistance to highly chronic and low complexity patients.

From this point of view Assogenerici, Fimmg, Simg and Cittadinanzattiva share the need for a safe return of patients to the offices of general practitioners for a resumption of ordinary assistance activities in the area and for a recovery of the indispensable relationship with the patient who make use of and value all the innovative tools and services already made available during the lockdown period, without forgetting that there are still over 20,000 people in home isolation throughout the country who have the right to find constant and adequate answers to their needs assistance from your family doctor.

Below are the points that Assogenerici, Fimmg, Simg and Cittadinanzativa consider indispensable for a return to normality of territorial assistance which in our country offers concrete health answers to over 2 million citizens every day.

NEEDS AND EVIDENCE FOR THE RE-START OF TERRITORIAL MEDICINE

 THE IMPORTANCE OF GENERAL MEDICINE. The anguish of the National Health Service during the Covid-19 emergency has shown everyone the need to invest more in the area, in primary care and above all in general medicine, supporting it with the human and technological resources necessary to amplify and systematize its prevention action , initiative, assistance to chronicity, support to non self-sufficiency, terminality and small acuities, which proved to be invaluable during the pandemic crisis.

• THE URGENCY TO START AGAIN FROM TERRITORIAL ASSISTANCE. After two months of lockdown, many patients have begun to access the offices of general practitioners again, despite the fact that the restrictive rules for visits have not changed and still require an appointment and a first telephone evaluation, except for serious cases that cannot be postponed.

In view of the progressive resumption of assistance activities - especially in relation to the need to start the procedures for the extended flu vaccination in advance - it is essential to put GPs in the optimal conditions for the resumption of normal assistance activities in the area. For this reason, the role of protocols disseminated by general practice organizations in support of healthcare professionals has been essential.

 NEW TOOLS FOR CONTINUITY OF CARE. Telemedicine and dematerialized prescriptions are indispensable tools for the GP's activity: they do not serve to replace consultation or in-person visits but, for example, to guarantee the chronically ill the continuity of care they need.

It is essential to implement territorial healthcare by improving the use of all available technological tools, also to enhance the quality of the time dedicated to direct contact with the patient.

 INVESTMENTS AND RESOURCES. The latest budget law allocated 235 million euros for the purchase of small diagnostic tools for use in general medicine: funds distributed but not yet used by the Regions.
It is necessary to speed up the acquisition by GP surgeries of all those tools relating to first level diagnostics (ECG, ABPM, Holter, generalist ultrasound, spirometry...) which will be increasingly essential to meet the growing demand for health, in particularly for the management of the chronic patient.

 EXPANSION OF THE PHARMACEUTICAL ARMAMENTARY OF GPS. Allowing GPs to prescribe new treatments for important chronic pathologies, such as atrial fibrillation and diabetes, is essential to enhance territorial assistance, allowing the professional freely chosen by the patient to carry out his/her assistance activity in the best possible way, reducing the burden of work that weighs unduly on hospital structures today.

 THE ROLE OF GENERIC DRUGS AND THE NEW GOVERNANCE OF DRUGS. The pharmaceutical tools available to healthcare professionals during the COVID emergency largely consisted of off-patent drugs which made it possible to better deal with the emergency by offering timely solutions even where procurement was more complex. For this reason, a profound rethinking of the drug governance dynamics is needed, starting with the governance reform. This must restart as soon as possible from the revision of the expenditure ceilings, the forms of distribution of different categories of off-patent drugs and the price and reimbursement mechanisms, aiming to bring back to the general practitioner's equipment and to the territorial network of pharmacies all the products that they have so far been artificially excluded, guaranteeing the widest and easiest access for patients to the care they need.

 TRAINING AND INFORMATION FOR GENERAL MEDICINE. The organizational protocols adopted by the general practitioners' clinics for post-emergency recovery will also provide for adequate rules for the resumption of scientific information activities on the drug, an activity that must be adequately valued also as part of the continuous updating process envisaged for the profession medical.