ACTIONS AGAINST CHRONIC RESPIRATORY DISEASES (CRDs( ITALY

Transcription

1 ACTIONS AGAINST CHRONIC RESPIRATORY DISEASES (CRDs( CRDs) ) IN ITALY STEFANO NARDINI Department Pulmonary Disease Vittorio Veneto Hospital (TV), ITALY Secretary General, AIMAR On behalf of the Centre for Diseases Control & Prevention (CCM) of the Ministry of Health INDICE

2 CRDs,, CURRENT SITUATION IN ITALY SMOKING CESSATION NOT STANDARDISED

3 CRDs,, CURRENT SITUATION PRIMARY PREVENTION SECONDARY PREVENTION TERTIARY PREVENTION IN ITALY SMOKING CESSATION NOT STANDARDISED

4 CRDs,, CURRENT SITUATION IN ITALY PRIMARY PREVENTION good protection from ETS (smoking ban) ) and pollutants (EU laws) SECONDARY PREVENTION low community awareness on CRDs spirometry underused - CRDs underdiagnosed poor integration of primary care/specialists - CRDs undertreated TERTIARY PREVENTION COPD diagnosed late in its course specialists have adequate knowledge of existing guidelines but there are insufficient chest units pulmonary rehabilitation not homogeneously delivered SMOKING CESSATION NOT STANDARDISED

5 CRDs,, CURRENT SITUATION IN ITALY (2007) National health plan includes CRDs as one of its four priorities (2006) A White paper ( Guadagnare salute ) published by the Government (Spring 2007) on how to change lifestyles to prevent Chronic Diseases (smoking included) Revision of the list of diseases assisted by local health services (LEA) may include smoking (underway May 2007)

6 CRDs,, CURRENT SITUATION IN ITALY (NOW) National health plan includes CRDs as one of its four priorities (2006) A White paper ( Guadagnare salute ) to be published by the Government on how to change lifestyles to prevent Chronic Diseases (smoking included) ) (2007) The list of diseases assisted by local health services (LEA) now includes smoking cessation (DPCM 23/4/2008) COPD officially declared a Social disease (total reimbursement from NHS for drugs and assistance) ) (DPCM 23/4/2008)

7 GARD IN ITALY (1) COLLABORATING PARTIES IN GARD-ITALY AIMAR (2005) SIMeR (2006) CCM (MINISTRY OF HEALTH) (2006) AIPO (2007) LIBRA PROJECT (2007) CCM HAS ASSUMED THE ROLE OF COORDINATOR OF GARD IN ITALY, UNDER THE DIRECTION OF DONATO GRECO; PAOLO D D ARGENIO, GIOVANNA LAURENDI COORDINATORS

8 GARD IN ITALY (2) CCM IS ACTING AS INITIATOR: A MEETING ORGANISED IN ROME WITH MANY RESPIRATORY SOCIETIES AND PATIENTS ORGANISATIONS TO INTRODUCE GARD-ITALY (J. BOUSQUET CHAIRED THE MEETING) (JUNE, 2007) A SESSION ON GARD DURING THE AIMAR CONSENSUS CONFERENCE IN RESPIRATORY MEDICINE (JOINTLY ORGANISED BY CCM-AIMAR) (N. KALTHAEV CHAIRED THE SESSION) (OCTOBER, 2007)

9 EACH SESSION OF THE C.C. PRODUCED (BY VOTING) A SERIES OF EVIDENCE-BASED STATEMENTS ABOUT THE MOST RELEVANT RESPIRATORY MEDICINE ISSUES GARD IN ITALY (3).WHICH WERE PUBLISHED IN ISSUE # 2 OF AIMAR s s INDEXED OFFICIAL JOURNAL, MULTIDISCIPLINARY RESPIRATORY MEDICINE (MRM)

10 GARD IN ITALY (4) CCM CALLED FOR AN EXPERT GROUP OF PHYSICIANS (INCLUDING G.W. CANONICA, G. VIEGI) ) TO PRODUCE A WHITE PAPER ON CRDs IN ITALY (NOVEMBER, 2007) ON APRIL, AIMAR ORGANISED 17 SIMULTANEOUS REGIONAL CONSENSUS CONFERENCES ( PRIMAVERA AIMAR - AIMAR SPRING ) ) TO DISSEMINATE THE STATEMENTS ON CRDs. THE FIRST PART OF THESE REGIONAL CONFERENCES WAS BROADCAST FROM ROME THROUGH VIDEO-CONFERENCE: IT PRESENTED GARD (N. KALTHAEV, SPEAKER) AND ITS ACTIONS IN ITALY THEN DISCUSSION AND VOTING FOLLOWED AT THE LOCAL LEVEL. TO STIMULATE THE DISCUSSION: THE C.C. STATEMENTS DATA FROM THE SOS-BREATH STUDY

11 SOS BREATH: : THE FIRST STUDY IN ITALY ON THE GARD APPROACH TO CRDs ( ) 2007) Health education on CRD symptoms TV spots (M. Lippi, coach of the National soccer team, testimonial) Leaflets in GP clinics Professional education on diagnosis and treatment of CRDs to GPs to Pulmonologists Spirometry carried out

12 RESULTS 414 people carried out spirometry No CRDs = 58 Asthma= 74 COPD= 221 CB= 61 Out of 221 COPD cases,, 208 (94%) were not previously diagnosed Out of these 208 previously undiagnosed COPD, 175 (84%) were led to spirometry after the campaign CONCLUSIONS The GARD approach is feasible and effective A substantial underdiagnosis of COPD is confirmed in Italy Our budget was too low to reach a great number of citizens: we suggest that - according to NHP - the MoH starts a campaign of prevention/appropriate treatment of CRDs, supported by scientific societies: GARD can be of help

13 GARD-ITALY A LOOK TO THE FUTURE CCM AIMAR

14 GARD-ITALY A LOOK TO THE FUTURE CCM/RESPIRATORY SOCIETIES WHITE PAPER ON CRDs IN ITALY DUE FOR PUBLICATION AT END OF IT WILL BE THE BASIS FOR: 2009-YEAR OF THE BREATH ] On CRDs ADVOCACY HEALTH EDUCATION PROFESSIONAL EDUCATION OFFICIAL LAUNCHING OF GARD-ITALY AIMAR AN ANALYSIS OF THE RESULTS OF THE 17 SIMULTANEOUS REGIONAL CONFERENCES AN AUDIT AMONG CHEST PHYSICIANS ON IMPLEMENTATION OF ERS GUIDELINES ON SMOKING CESSATION IN RESPIRATORY PATIENTS

15 CONCLUSION In Italy, the GARD model is being implemented by CCM with the collaboration of scientific societies. We can now develop a comprehensive strategy of primary and secondary prevention of CRDs gathering all the interventions already carried out by the government on specific risks (e.g. tobacco smoking, indoor and outdoor pollution) that so far have remained fragmented. We hope that our experience in Italy may be of help to other European Countries.

16 THANK YOU Stefano Nardini