Francesca Bravi

Exploring Continuity of Care: The Patient Voice

Background: Oncology is one of the priorities of public health given its high incidence and prevalence. In 2010 there were 8 million deaths caused by cancer. In Italy neoplastic disease is the second highest cause of death. Considering these data, we need to guarantee appropriate, quality healthcare responses. In order to monitor the quality of cancer care pathways, we intend to explore continuity of care from patients’ perspective, identifying the dimensions that define continuity. Methods: Semi-structured interviews with 30 cancer patients (4 colorectal and 26 breast cancer) who received treatment at different service points of the Area Vasta Network (AVR), Italy. To identify the macro-categories of continuity, all interviews were transcribed and analysed using framework analysis, assisted by a computer software package for analysis of qualitative data (N-VIVO 10). Simultaneously, a literature review was carried out using the Pubmed database to examine the continuity of care measures validated. Results: From the narratives of 30 patients, different continuity of care’s dimensions emerged, for example the presence of a professional who knows the patient’s illness history and takes him/her from initial diagnosis to followup care, guaranteeing him/her accurate information; a multi-professional team. The same aspects result central and transversal to 5 questionnaires identified in literature. Conclusions: The analysis allows us to identify 3 central and transversal dimensions of continuity of care: informational, organizational and relational; confirming the continuity of care model produced by Haggerty et al. It follows that in order to cater to the needs of cancer patients; we need to focus simultaneously on these three dimensions along the cancer care pathway. In line with these results, we are developing the first Italian patients experience continuity of care tool.

Cesarean section rates in Italian regions: 1998-2002

Cesarean section (c-section) rates have been increasing in many countries, and too frequently this rise does not seem to be justified by clinical grounds. To reduce c-section rates and achieve a proportion of 20% is among the goals of the Italian National Health Plan. In the following paper we provide an update on the distribution of rates amongst Italian regions and describe the association between regional hospital volumes and c-section rates. The national c-section rate increased from 31% in 1998 to 36% in 2002. The rates varied among regions and ranged from 20% in the Province of Bolzano to 56% in Campania. A significant association was observed between the regional hospital volumes for deliveries and c-section rates, regions with low hospital volumes performed more c-sections than high volume regions.

Patient engagement in health care. New perspectives in oncology

During the last decade, an increasing number of studies has been focused on patient engagement programs through which patients can be effective and informed managers of their health and health care. Based on our recent review, studies examining the nature of patient participation in service planning have found that most activities are limited to various forms of consultation, rather than the interactive partnerships advocated for treatment decision-making. Despite this clear evidence, many people want to play an active role in their own healthcare. They want to know how to protect and improve their health when they are well; and when they are ill, they want information about treatment options and likely outcomes. Consistent with these considerations, this paper intends to underline the importance to engage patients, to describe some different interventions to make patient effective informed; and, finally, to show some pilot projects from around the world, with a special focus on cancer care service of Ontario.