Implemetation status of Law 38 of March 15th, 2010

Transcription

1 Implemetation status of Law 38 of March 15th, 2010 Dr. Marco Spizzichino Ministero della Salute Direzione della Programmazione Sanitaria Ufficio XI «Cure palliative e terapia del dolore» Ministry of Health Directorate of Health Planning Bureau XI "Palliative care and pain therapy

2 Law march 15, 2010, n. 38 "Provisions to ensure access to palliative care and pain therapy " " Art. 1. (Purpose). 1. This law protects the citizens right to access to palliative care and pain therapy

3 The new law on palliative care and pain therapy Law. 38, 2010 the Law establishes two distinct but integrated networks: the network of palliative care and the network of pain management; identifies the key management roles and educational/training and upgrading programs of the professionals involved; finance information campaigns; establish a ministerial structure appointed to monitor the network of palliative care and pain management; for the first time takes into account the paediatric specificity both for palliative care and pain therapy

4 CUPIDO CUra Previeni Il Dolore Care Prevent Pain roadshow campaign live without pain, non-profit organization April May 2011

5 Are you aware of the Law 38 on Palliative Care and Pain Therapy? 29,7% 70,3% No NO Si YES

6 ARTICLE 6 of Law 38/2010 The transition to the new project "Hospital territory without pain" stems from the following needs: Shift the focus of the assistance from hospital care to the territory; Rely on hospitals only for complex cases; Involve in the health care process the GPs physicians

7 HOSPITAL TERRITORY WITHOUT PAIN HOSPITAL OUTPATIENT DEP. GPs HOSPITAL HUB HOSPITAL OUPATIENT DEP. HUB SPOKE SPOKE OUPATIENT DEP. GPs SPOKE SPOKE AFT AFT AFT AFT AFT AFT GPs

8 Guidelines for the promotion, development and coordination of regional operations (Article 3 paragraph 2) It is believed essential, for an actual development of palliative care and pain therapy, the setting up, by means of proper regional and business management provisions, of a structure specifically dedicated to the coordination of the networks

9 Art. 5 paragraph 2 of law 38 of March 15th, 2010: «are identified specific professional figures with specific skills and experience in the field of palliative care and pain therapy, even for the pediatric age, with particular reference to general practitioners and medical specialists in anaesthesia and intensive care, geriatrics, neurology, oncology.» It is expected to include, in the list of professionals qualified to work in the networks, hematologist and physician of internal medicine.

10 UNIVERSITY MASTER The decrees are referred to the post-graduate training The contents of masters provided in art. 8 of the law are defined by five specific decrees Medical therapist of pain Health professions of nurse, pediatric nurse, physical therapist, rehabilitation therapist; Physicians for pediatric palliative care and pain therapy Psychologists Palliative care physicians Decrees have been examined and approved by Health Governing Council on December 13th,2011 and are ready to be signed by the Ministry of Health.

11 Articolo 5 paragraph 3 of the law 38 of March 15th 2010 Demand to define by means of an agreement the minimum requirements and organizational conditions necessary to accredit the care facilities of palliative care and pain therapy networks in adult and pediatric patient.

12 Agreement between State and Regions Conference of State-Regions (Permanent Conference for Relations between State, Regions and Autonomous Provinces) on the minimum requirements and the necessary organizational procedures for the accreditation of the network of palliative care and pain management (article 5, paragraph 3) The output of this agreement is a document where, for the treatment of pain, centers hub and centers spoke are defined on the base of the activities carried out both in terms of performance and in terms of business volumes.

13 The final document is the result of the work processing of the three groups of experts Palliative care adult Pain therapy adult Pediatric palliative care and pain therapy

14 Accreditation criteria of the pain therapy network It is meant for Pain Therapy Network a functional and integrated combination of all the activities of pain therapy provided in different care settings, which aims to improve the quality of life of adults suffering from pain regardless of its etiopathogenesis, reducing the degree of disabilities and promoting their reintegration into the social and labor context and that simultaneously satisfies the following requirements: 1. Regional organizational structure to coordinate the Network of Pain Therapy 2. Supplied services structures of the Network of Pain Therapy 3. Protection of the citizen in order to have access to pain relief 4. Continuity of care 5. Operativeness of dedicated multiprofessional team, as perart. 5 Paragraph 2 6. Continuing education for professionals 7. Misurement of pain 8. Active and comprehensive care and protection of the dignity and autonomy of the patient 9. Information programs on pain management to the citizens 10. Programs of performances evaluation and regional information system

15 Aim of the final document Determine comprehensively the minimum requirements and the organizational modalities to meet the needs of the patient and his family in every place of care of the whole national territory so as to maintain the quality of care in a uniform manner throughout the country.

16 MONITORING Art. 9 of the law n. 38 of March 15th 2010 < at the Ministry of Health has been activated ( ), the monitoring for the palliative care and pain therapy associated with neoplastic diseases and chronic and degenerative diseases... The Ministry shall monitor, in particular: a) data on the prescribing and use of drugs in the treatment of pain, and in particular of the opiate analgesic drugs; b) the development of the two networks.; c) the progress of the two networks.> Institution of the Bureau XI of the D.G. of the Health Planning

17 Overview dashboard

18 Pain management area of hospital and outpatient «the set of diagnostic and therapeutic interventions designed to identify and apply to the chronic forms of disease suitable and appropriate drugs, surgical, instrumental, psychological and rehabilitation therapies, among them variously integrated, in order to develop an appropriate diagnostic and therapeutic path for the suppression and control of pain»

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20 Trend Peripheral neurostimulator implant Female Male YEAR Total Number of Interventions Number of Interventions Total

21 Trend Peripheral neurostimulator implant

22 ARTICLE 10 OF LAW 38/2010 Simplification of the procedures to access drugs used in pain therapy

23 Monitoring of opioid use

24 Consumption per capita of strong opioids 1 quarter 2011 MAT (Mobil Annual Time) 10 9, ,47 4, ,03 2, , Europa Germania UK Francia Spagna Italia Fonti: IMS MIDAS Marzo 2011 Portale Unione Europea

25 Euro European market strong opioids 1 quarter 2011 vs 1 quarter 2010 MAT (Mobil Annual Time) ,04% ,80% ,13% +8,86% +2,87% +23,05% - Europa Germania UK Francia Spagna Italia Q MAT Q MAT Fonti: IMS MIDAS Marzo 2011 Portale Unione Europea

26 Consumption per capita strong opioids 2,00 1,80 1,60 1,40 1,20 1,00 0,80 0,60 0,40 0,20 0,00 0,73 0,75 0,73 1,31 1,89 0,89 1,73 1,23 1,04 1,12 1,16 1,01 1,58 1,00 1,26 1,01 1,58 1,16 1,66 1,28 1,17

27 Consumption per capita weak opioids 1,74 0,58 0,66 0,46 0,36 0,94 1,18 0,51 0,95 0,92 0,71 0,49 0,68 0,68 1,07 0,64 0,61 0,49 0,75 1,02 0,72 0,78

28 Consumption per capita other drugs 10,83 9,58 10,32 7,49 8,65 8,53 10,91 10,81 7,18 8,36 9,55 8,14 7,20 9,50 12,19 10,83 11,28 7,46 8,21 9,38 8,50 9,10

29 The European Network of Pain Therapy The Ministry of Health has carried out a survey of the structures designed to coordinate the network of pain management in the present EU member states. Up to now the information was provided by France, Spain, England and Luxembourg

30 COMUNICATION Art. 4 of the law 38 of March 15th 2010: «The Ministry of Health, in accordance with the regions and autonomous provinces of Trento and Bolzano, in the years promotes the making of institutional and communication campaigns designed to inform citizens on modalities and criteria to access the services and assistance programs»

31 Comunication Project Ministry of Health - Agenas Realization of a slogan, a logo, a poster and a screenplay to make a spot

32 The poster: Pain has no boundaries, it is lived and written in all languages... but finally something can take it away... and the sky appears again Communication Project Ministry of Health - Agenas

33 Lo slogan Il logo I CAN T STAND YOU ANYMORE pain must not be supported but eliminated.

34 Spot televisivo

35 Thank you