Chronic pain in Lazio affects around 1.5 million people in its mild and moderate form, heavily influencing the quality of life of patients and causing disability, social and work isolation. Throughout Italy, there are approximately 500 affected citizens 13 million of people, and this entails high economic costs 36.4 billion eurosof which 25.2 billion in indirect costs. A worrying reality is given by the fact that recent estimates indicate a strong inappropriateness in pharmacological treatments and uncertainty in treatment paths.
This is the picture that emerged during the event Prescriptive appropriateness and correct information are key factors in the management of chronic pain – Lazio Region organized by Healthcare Enginewith the unconditional contribution of Angelini Pharma. Furthermore, around chronic pain there are still prejudices, false myths and fake news that lead patients to carry out incorrect actions, from self-medication to searching for diagnoses on the internet, to suspending therapy because they are poorly motivated or disappointed by expectations.
The importance of prescriptive appropriateness
The prescriptive appropriateness of painkillers plays an important role not only in optimizing therapeutic efficacy, but also in minimizing common side effects (gastrointestinal, renal, cardiovascular), largely due to inappropriate use of NSAIDs (anti-inflammatory drugs non-steroidal drugs), and avoid unwanted interactions that may lead to additional costs in the healthcare sector.
Mild and moderate chronic pain has a negative impact on the daily life and work ability of affected people and places a heavy financial burden on healthcare systems. Several studies have highlighted that the average annual cost per patient amounts to 4,556 euros, of which 69% is represented by indirect costs as a direct consequence of the compromised working capacity that pain can cause. Overall, the impact of chronic pain costs on public health spending would be 9.6%, with an impact on GDP of 2.3%. These results confirm that chronic pain entails high costs, both medical and social, even in Italy.
Necessary improvement actions
In this scenario it is necessary to intervene as soon as possible on some critical issues with concrete improvement actions: greater attention to the healthcare governance of pain, even in cases of mild and moderate pain, investment in the efficiency of pain therapy networks (resources and structures adequate), an improvement in patient access to care (integrated PDTA and reduction of economic barriers), adequate training of health professionals, broader awareness of public opinion and political decision makers on the importance of investing in prevention, in the diagnosis and treatment of chronic pain.
“The inappropriateness of prescribing basic drugs for mild and moderate pain plays a crucial role – has explained Claudio Zanon, Scientific Director of Motore Sanità. “The Osmed report indicates that the inappropriate prescribing of NSAIDs is burdensome for the NHS and regional health services, as well as for health; in fact, when not used appropriately, NSAIDs cause important side effects. Recent studies conducted on a population of over 9 million patients have highlighted a high inappropriate and non-indicative use of NSAIDs.”
Zanon states that “it is It is known to the scientific community that most oral NSAIDs can cause serious side effects in the upper gastrointestinal tract. In this context, general medicine plays a fundamental role in the appropriate prescription of drugs (paracetamol is the first choice in the management of mild and moderate pain in the absence of an inflammatory state). An example of good practice on these aspects was the publication by the Ministry of Health of the Guidelines on the treatment of chronic non-cancer pain”.
The role of the family doctor
And then there is the role of the general practitioner who is increasingly central in the process of healthcare digitalisation and the doctor-patient relationship. Rino Moraglia, Strategic Director of NetMedica Italia, says this: “Digital services to support basic medicine today play an unavoidable role in guaranteeing the appropriateness of care. The digital Health Strategy of general practice will be decisive in responding to the challenge of new territorial models of care and improving the appropriateness of treatment of chronic pain. Digital proximity will give greater strength to the relationship of trust between doctor and patient.
“Organization, monitoring, awareness and initiative are the key concepts around which the development of the Digital Health Strategy of General Practice revolves, an innovative and concrete project that aims to make healthcare interventions appropriate, also through training, communication and dissemination of the relationship digital. Making everything as easy and possible, to guarantee serenity and effectiveness for doctors and patients” concludes Moraglia.
AFT crossroads of appropriateness and clinical consultation
Giovanni Cirilli, FIMMG Regional Secretary, in his report indicated the AFTs (Territorial Functional Aggregations) as the unavoidable node to guarantee results, correct information and appropriateness. Specifically for prescriptions of NSAIDs, the main critical issues that we encounter today – Cirulli specified – concern the failure to adhere to specific therapeutic indications (as in the case of minor pain and unspecified inflammatory conditions that require self-medication drugs), the underestimation of the risks associated (such as histories of ulcer, renal failure and other risk factors), failure to combine with proton pump inhibitors (PPIs) in patients at high risk of gastrointestinal complications, inadequate monitoring (such as lack of follow-up and periodic monitoring of renal and cardiac function in elderly patients or those with comorbidities).
Finally, to improve appropriateness, Cirilli recommends: “Adherence to guidelineshow to follow the instructions in note 66, Always avoid the use of NSAIDs for conditions not included in the guidelines, evaluate the individual clinical history of the patient, including any contraindications and risks associated with the use of NSAIDs. Furthermore, it is fundamental educate the patientinforming him of the risks and discouraging the independent use of the drug, and continuously monitoring the correlation with the patient’s symptoms”.
The importance of healthcare collaboration
In the context of modern healthcare, chronic disease management represents a growing challenge that requires an integrated and proactive approach. Fulvio Ferrante, Director of the Department of Diagnostics and Pharmaceutical Assistance of the ASL Frosinone, emphasizes the need for new projects and greater collaboration between the various players in the healthcare system. He explains Ferrante: “The change in the management of therapy for chronic diseases requires, in addition to a proactive attitude on the part of all actors in the healthcare context, also new projects to support this process. It is essential to improve and facilitate communication between the different levels of care within healthcare companies: general practitioners, district managements, hospital managements, hospital doctors, specialists and hospital and community pharmacists.”
Fulvio Ferrante adds that “greater collaboration could optimize the management of drug therapy and align local prescribing with clinical best practices. According to the latest national collective agreement, general practitioners take on a particularly important role. The district directors, supported by the pharmaceutical service, are responsible for managing the affiliated pharmaceutical expenditure, also through moments of discussion with the prescribers. This approach aims to improve the quality of medical prescriptions.”
Every year, the Lazio Region identifies specific areas on which to review the requirements, through the use of appropriateness indicators. We hope for an increasingly efficient integration between hospital and territory in the future, with the aim of following the patient in all phases of the disease. “This would allow the patient to be oriented in a unique and shared diagnostic-therapeutic path, guaranteeing a feeling of protection and protection. Furthermore, this approach aims at correct allocation of resources and control of pharmaceutical spending” concludes Fulvio Ferrante.
