Territorial care paths and guidelines for asthma and COPD

Maxer Consulting conducted a research, updated on May 2013, which aims at providing the healthcare stakeholders with an overview of the guidelines and Diagnostic and Therapeutic Care Paths (PDTA) implemented on the Italian territory at regional, sub-regional and wide area levels for two important chronic diseases affecting the respiratory system: chronic obstructive pulmonary disease (COPD) and asthma.
In addition to identifying and describing the key features of each PDTA, the research shows a cross-sectional comparison between paths and analyses their progress and implementation.
The analysis of the 19 Regions and 2 Autonomous Provinces within the Italian territory found that:
• 8 Regions were equipped with instruments (protocols, paths, profiles or guidelines). In particular, Piedmont developed a Integrated Care Profile (PIC) for COPD; Liguria produced a protocol on the integrated management of COPD; Veneto developed regional guidelines for asthma; Friuli Venezia-Giulia implemented a consensus document for GPs and hospital doctors regarding a PDTA for COPD; Tuscany developed guidelines for asthma and guidelines for COPD; Campania has recently approved a PDTA for COPD; Lazio has put in place a therapeutic path for COPD and asthma, and Puglia a path for the diagnosis and treatment of chronic obstructive pulmonary diseases and asthma.
• 5 ASL (Local Healthcare Organization) in Lombardy put in place the Chronic Related Group (CREG) project for COPD and other chronic, non-respiratory pathologies.
• Some other local entities (especially in Emilia Romagna, Tuscany and Trentino-Alto Adige) and wide areas (e.g. Verona within Veneto) have developed PDTAs for the above mentioned respiratory diseases.

Research results
• Strong heterogeneity of PDTAs and Regional guidelines in terms of distribution in the Italian territory.
• Relevant differences among Regions, concerning the underlying reference models, the addressed issues, the used criteria and the selected indicators.
• Difficulties in finding, comparing and formalizing data on the application of paths, both due to the poor cooperation of the healthcare professionals surveyed, and to the strong heterogeneity among paths and monitored territories, aspects and parameters.

Critical aspects
• Heterogeneity, scarce sharing and not easy comparability of process and outcome indicators, and taking charge of the disease indicators, whereas adopted and specified in the documents
• Applicability of the guidelines by the MMG in clinical practice
• Collaboration / integration between GPs and pulmonologists
• Mutual trust between hospital doctors and GPs
• Audit and peer reviewing activities among GPs
• Training of healthcare professionals on the importance of healthcare paths;
• Availability of information systems and computerized tools for sharing clinical and administrative data (i.e. medical records, databases, etc.).
• Patient satisfaction with respect to the treatment and services received.