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Gavino Maciocco Dipartimento di Sanit Pubblica Universit di Firenze XXIII Congresso Nazionale CSeRMEG Costermano del Garda 29 ottobre 2011

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Distribuzione % delle cause di morte in Paesi con differenti livelli di reddito

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SECONDO DUE DIFFERENTI SCENARI

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BIG MAC ALLA SALSA DI STATINE ?

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SIAMO A RISCHIO DI DIVENTARE A RISCHIO ? 4 September 2010

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15 BMJ International classification of non-diseases (ICND)(N= 200) BMJ International classification of non-diseases (ICND)(N= 200) Baldness Irritable bowel syndrome Osteoporosis Menopause Cellulite Testosterone deficiency Ageing Pregnancy Erectile dysfunction Social fobia Chronic fatigue syndrome Seasonal affective disorders Unhappiness Anxiety about penis size Loneliness Tennis elbow Chinese restaurant syndr. etc., etc. Source: BMJ 13.04.02

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SI PU FARE UN SACCO DI SOLDI SE SI ARRIVA A CONVINCERE I SANI CHE IN REALT SONO DEGLI AMMALATI R. Moynihan et al. BMJ 2002 BMJ 13,April 2002 Too Much Medicine?

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Tabella 3. Prevalenza di condizioni morbose e fattori di rischio nei soggetti di 50 aa. e oltre. USA e 10 paesi europei*, 2004 USAEUROPAUSA/Europa differenza Malattie cardiache21,811,410,4 Ipertensione50,032,917,1 Ipercolesterolemia21,719,62,1 Ictus/Malattie cerebrovascolari5,33,51,8 Diabete16,410,95.5 Malattie polmonari croniche9,75,44,3 Asma4,44,30,1 Artrite53,821,332,5 Osteoporosi5,07,8-2,8 Cancro12,25,46,8 Obesit33,117,116,0 Fumatori20,917,83,1 Ex-Fumatori31,725,26,5 Mai fumato47,357,09,7 * Austria, Danimarca, Francia, Germania, Grecia, Italia, Olanda, Spagna, Svezia, Svizzera. Fonte: Rif. Bibliog. 11 Malattie cardiache 21,8 11,4 Diabete 16,4 10,9 Cancro 12,2 5,4 USAEuropa Obesit 33,1 17,1

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Promozione della salute

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E cruciale che gli individui si assumano la loro responsabilit nei confronti della loro salute cardiovascolare, ma necessario che i politici affrontino seriamente la questione delle diseguaglianze nella salute e riducano il potere delle lobbies delle industrie del cibo e del tabacco che hanno linteresse a perpetuare lo status quo.

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Sanit diniziativa Promozione della salute

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70-80% dei pazienti Livello 1 Con il giusto supporto le persone possono imparare a essere attivi protagonisti della loro condizione 70-80% dei pazienti Livello 1 Con il giusto supporto le persone possono imparare a essere attivi protagonisti della loro condizione Livello 2 Pazienti a alto rischio DISEASE MANAGEMENT Livello 2 Pazienti a alto rischio DISEASE MANAGEMENT Livello 3 Pazienti molto complessi CASE MANAGEMENT Livello 3 Pazienti molto complessi CASE MANAGEMENT PROMOZIONE DELLA SALUTE PROMOZIONE DELLA SALUTE

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DENMARK FRANCE GERMANY THE NETHERLANDS SWEDEN UNITED KINGDOM AUSTRALIA CANADA

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The overall aim that we set ourselves in this book was to compile an in-depth assessment of the health system response to the rising burden of chronic disease in each of the eight countries, by focusing on three key areas: (1) a detailed examination of the current situation; (2) a description of the policy framework and future scenarios; and (3) evaluation and lessons learnt, building on a common template developed by the editors.

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The template was informed, to great extent, by the Chronic Care Model (CCM) developed by Wagner and colleagues in Seattle. This model presents a structure for organizing health care; it comprises four interacting components that are considered key to providing high-quality care for those with chronic health problems: self-management support, delivery system design, decision support, and clinical information systems.

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DENMARK FRANCE GERMANY THE NETHERLANDS SWEDEN UNITED KINGDOM AUSTRALIA CANADA

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THE CHRONIC CARE MODEL

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Barbara Starfield

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Person-focused care over time makes it possible to identify, early in life, those conditions that are likely to influence subsequent ill health and, therefore, to attempt to reduce their impact. It also provides the continuity of attention that is important in reducing the impact of chronic illnesses and reducing the likelihood of the progression to more serious illness and to more multimorbidity.

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We need guidelines that are appropriate to person-focused care, not disease- focused care. Only primary care physicians can understand this, because they do not focus on particular organ systems and because they experience these realities every day in their practices. Primary care physicians will have to continue to advocate for primary care- oriented health systems, because it is the only hope for achieving greater equity through appropriate medical intervention s.

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