“Up until the pandemic, telemedicine was the prerogative of a few experts in the field. The Covid emergency forced a sudden change of perspective towards telemedicine, which however took place in a context of technical-scientific knowledge and organizational awareness, at an institutional and health level, not adequate. Then came the Pnrr which sanctioned the need to speed up to stay within the deadlines and reporting required by the EU, something our system is not used to. We therefore have the need to make plans with a group of professionals who are trying their hand, for the first time, on the implementation of large-scale telemedicine projects that are not experimental, but capable of providing effective services for citizens and that last over time”. Thus Francesco Gabbrielli, director of the National Center for telemedicine and new assistance technologies of the Higher Institute of Health (ISS), in an article published in ‘Allies for Health’), the portal dedicated to medical-scientific information created by Novartis.
“The health landscape – writes Gabbrielli – has evolutionary elements that are opening up great prospects and opportunities to which, at this moment, are added a great uncertainty on the organization of daily health activities further aggravated by the lack of personnel. A lot of competence is therefore needed, which we must create by investing in the training of professionals, and develop best practices and medical-health guidelines that clarify where and how to intervene”. As an Institute, “even before Covid, starting from clinical teleneurophysiology, we began to carry out a series of consensus documents, preliminaries to best practices and guidelines. Currently there are 6 active consensus groups and one for developmental age guidelines. We are accelerating tele-rehabilitation and psychological support in developmental age because we are registering an enormous growth of neuropsychological problems in adolescents, from 12 to or 20 years old”.
Among “the consensus groups there is also that for hospital telepharmacy. The idea is to ensure that hospital pharmacists – who by law have the duty to follow up, after discharge, patients with specific therapies provided only in hospital – can verify the therapeutic adherence of very specialized and expensive drugs, monitoring any interactions with diet or other medications. We are trying to identify the key elements for this work to become a best practice to guarantee better post-hospitalization healthcare for patients in the area.
“We organize consensus groups – underlines the expert – with the reference scientific societies for the individual specialties to which independent consultants are associated to arrive at recommendations. The text – based on scientific data – is then sent to patient associations for any proposals or comments on organizational issues. The document is published in the ISS Reports. This system makes it possible to optimize document creation times: the ability of patient associations to express themselves is greater if we present a work with already validated scientific solutions to be verified from a practical/organisational point of view”.
From these documents “the best practices are drawn up – continues the expert – the scientifically validated indications which are the precursors of the real Guidelines and which have medico-legal value, as required by the Gelli law on health liability: the doctor is not punishable in practice if he has acted in compliance with the guidelines and, in their absence, with the best practices licensed by the National Guidelines System, an ISS evaluation body, which reviews the contents and publishes only those justified with sufficient scientific evidence” .
“These are important steps because the guidelines bind the structures to adapt – concludes Gabbrielli – It is clear, for example, that the patient with heart failure is followed up better in telemedicine than in presence. The studies prove it. If this practice is in the guidelines, health facilities, such as the local health authorities, must provide for it, it is not an option. Unfortunately, however, in Italy the telemedicine systems, digital therapies, telerehabilitation are not yet Lea (essential levels of assistance) and therefore can be requested but not demanded by citizens”.
The complete article is available at: https://www.alleatiperlasalute.it/la-voce-del-paziente/telemedicina-la-rivoluzione-digitale-ha-bisogno-di-formazione-e-linee-guida.
