The new care services in the area
To bring health services ever closer to home and to people's needs, the National Recovery and Resilience Plan (Pnrr), aimed at modernizing the country after the Covid-19 pandemic, as part of mission 6 dedicated to health, has allocated of resources to strengthen territorial assistance and reform its organization (regulated by the decree of the Ministry of Health 77/2022) with the establishment of new care services, such as: community homes, community hospitals and territorial operations centers.
With Pnrr funds, 1350 community houses will be built throughout Italy (in existing or newly constructed buildings).
The community house (cdc) is a widespread structure throughout the national territory, where a multidisciplinary team made up of: general practitioners, paediatricians of free choice, outpatient specialists, family nurses (also called "community nurses", with the task of early intercepting frailties and health and social care needs at home, monitoring the care pathways of chronic patients, supporting the caregiver and promoting correct lifestyles) , social workers and other health professionals (such as psychologists, physiotherapists and obstetricians).
Based on the catchment area in which the community house is located and depending on the number and type of services it provides, it is distinguished into:
- community house hub, open 24 hours a day, 7 days a week, present for every 40-50 thousand inhabitants, with the following services:
• primary care (through general practitioners, paediatricians of free choice and family or community nurses)
• single point of access (pua) to health services (such as home care), socio-health services (such as nursing homes and day centres) and social services (social assistance, contributions), which welcomes, informs and orients towards the competent services in the area based on to the needs of the citizen
• house assistance
• specialist outpatient for the most frequent pathologies
• nursing assistance (for medications, injections, emergency response for white codes, management of chronic pathologies)
• booking system for visits and exams linked to the cup
• social services
• associations promoting health and supporting patients and caregivers
• basic diagnostic tests (ultrasound, spirometry, electrocardiogram)
• continuity of care (former medical guard)
• withdrawal point
• the following are optional: counseling for adults and minors; oncological screenings; services for mental health, pathological addictions and neuropsychiatry for children and adolescents; sports medicine, vaccinations.
- community house spoke, open 12 noon, 6 days a week, which, unlike the hub, has no obligation to provide either diagnostic services, continuity of care, or a blood sampling point, in addition to the rest of the optional services for the facility hub.
With Pnrr funds, 600 territorial operations centers will be built throughout Italy.
There territorial operations center (cot), one for every 100 thousand inhabitants, it is operational 7 days a week managed by nurses and has the task of ensuring continuity of care in the area and between hospital and area.
The COT nurses, in fact, coordinate and activate the care services (health, socio-health and social) necessary for adequate care of the fragile person after hospitalization or reported to the home, avoiding that the family is left alone to manage the need .
The COT, depending on the needs of the patient, organizes the transfer from the acute hospital to the community hospital or to a rehabilitation facility, an RSA or a hospice.
Or, during hospital discharge you can activate home care or social services.
While for those who are already being treated at home, or in an intermediate facility, but have suffered a worsening, the COT may require hospitalization or nursing home, the activation of palliative care or enrollment in the day center.
With Pnrr funds, 400 community hospitals will be built throughout Italy.
Thecommunity hospital (odc) it is an inpatient facility with 15-20 beds, which performs an intermediate function between home care and hospital admission.
The construction of a community hospital is planned for every 100 thousand inhabitants throughout the national territory.
Within these structures, nursing care is guaranteed 24 hours a day, 7 days a week, with the support of social and health workers.
While medical assistance is provided for 4.5 hours a day, 6 days a week.
The community hospital welcomes patients who, after hospitalization in an acute department (for example, following a stroke or orthopedic trauma), once the critical phase has passed, still need treatment.
The patient may need to complete therapy with constant monitoring, complete the rehabilitation process or start artificial nutrition.
But the patient can also be sent from home to the community hospital at the request of the attending doctor or the local operations center.
The reason could be the worsening of the chronic pathology from which he suffers, which however does not require hospitalization (intended for acute cases).
The duration of hospitalization is a maximum of 30 days (extendable in exceptional situations).
The objectives of the community hospital are: to avoid inappropriate hospital admissions and to encourage protected discharges in more suitable places in one's home, while allowing the family to adapt the domestic space to the patient's new needs.
The care continuity unit is a mobile team within the health district, made up of a doctor and a nurse for the management of patients at home in particularly fragile situations (clinical instability, infectious diseases, epidemic outbreaks), also through the use of telemedicine.
