La CMMG di Soresina ha aderito al progetto regionale dei “Chronic Related Groups” (CReG)

Lo scopo di tale progetto è di gestire ed ottimizzare la presa in carico da parte del Medico di Medicina Generale delle patologie croniche più comuni. In questi tempi di ristrettezze economiche, vere o presunte, ci si è accorti che la gestione di questi gruppi di pazienti lasciava molto a desiderare, sia sul piano dell’utilizzo delle risorse stesse, sia sull’efficacia clinica degli interventi messi in atto. In pratica, mentre una parte della popolazione era insufficientemente controllata e rischiava di andare incontro a complicanze anche gravi (e costose per il SSN…), una parte invece accedeva a tali risorse in modo incontrollato, eseguendo accertamenti inutili o in sovrannumero a causa dello scarso coordinamento fra medici specialisti di branche diverse e medici di medicina generale.

È stato messo in atto quindi un sistema di gestione ottimizzato, coordinato dai medici di medicina generale, il cui scopo è far sì che tutti i malati cronici ricevano le cure ed eseguano gli accertamenti necessari (e solo quelli) per tenere sotto controllo a propria patologia. Questo implica il passaggio a un tipo di medicina detta interventistica, in cui il medico si fa parte attiva e contatta il paziente per essere sicuro che questo esegua nei tempi dovuti i controlli programmati e aderisca alla terapia, anziché aspettare che sia questi a recarsi presso lo studio del medico a richiedere la prescrizione (la cosiddetta medicina d’attesa).

Per poter mettere in atto una simile “rivoluzione copernicana” è necessario però un cambiamento nel tradizionale modo di lavorare del medico di medicina generale. Innanzi tutto, serve un elevato livello di organizzazione che sia in grado di aiutarlo e di alleggerirlo dal lavoro organizzativo e burocratico che il progetto richiede.

Non è infatti pensabile che un medico singolo possa far fronte agli impegni che il progetto comporta: servono gruppi di medici (almeno trenta) organizzati con personale amministrativo ed infermieristico in modo da avere un numero di pazienti sufficientemente alto dal punto di vista statistico per permettere il raggiungimento degli obiettivi e per realizzare le indispensabili economie di scala. Il gruppo di medici deve poi essere tutelato da un sistema societario come una cooperativa di medici (come la CMMG, appunto) che possa avere rappresentatività giuridica: occorre inoltre un accordo economico con un partner tecnologico che possa fornire le strutture e il know how necessari e garantire i flussi informativi con la Regione che deve monitorare la situazione. Al partner in questione poi spetta l’organizzazione di un call center telefonico per tenere i contatti con i pazienti,

E’ necessario poi prendere accordi preventivi con le strutture specialistiche che dovranno eseguire gli accertamenti programmati; il tutto poi andrà gestito da un sistema informatico con elevati standard di sicurezza e di rispetto della privacy, come richiesto dalle leggi vigenti.

 

Questa sperimentazione rappresenta una sfida per la medicina generale, cui viene richiesto un “salto di qualità” che le permetta di continuare a giocare un ruolo centrale nella cura della persona. La mancata presa in carico della cronicità, infatti, comporterebbe l’entrata in gioco di figure professionali diverse: strutture private accreditate, società di professionisti, cooperative sociali, assicurazioni private il cui scopo primario però non è l’accesso a giuste ed eque cure, ma il profitto, con le conseguenze ben immaginabili per la salute (e i portafogli) dei pazienti.

Questo porterebbe allo smantellamento della sanità pubblica, creando una forte discriminazione fa cittadini che possono permettersi le cure sanitarie migliori e quelli che semplicemente non hanno i soldi per curarsi.

Da ciò si deduce che quella dei CReG è la partita decisiva per il futuro della medicina generale e del sistema sanitario pubblico, equo e solidale che, pur con tante pecche, fino a qualche tempo fa era considerato uno dei migliori del mondo.

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