[Taking in charge of chronicity in Lombardy: balance sheet and revision perspectives after the pandemic.].

At the end of the first three years of experimentation of the Lombard reform of the Taking in Charge (PiC) of chronicity and frailty, it is possible to draw up a first summary balance. The covid-19 pandemic in the two-year period 2020-2021 had a negative impact on the implementation process of the PiC so much that its revision was necessary. The changes envisaged by Mission 6 of the PNRR, in synergy with the reform of Regional Law 22 and with the renewal of the primary care ACNs, open a new phase for the management of chronicity in Lombardy.

[The management of the chronic patient: explanatory models in comparison.].

The prevalence of chronic diseases represents a challenge for public health systems, which must cope with this phenomenon by reorganizing primary care, improving integration with hospitals, and involving those patients with one or more chronic conditions in their own care. The article proposes the categories of medical anthropology as an interpretative key to chronicity, promoting the realignment of the patient's explanatory models about disease with respect the models pertaining to medical knowledge and medical practices. In particular, the concept of risk plays a key role, which mainly concerns the asymptomatic phase of chronic cardio-cerebro-vascular and metabolic diseases and which must inspire educational and health literacy interventions to improve compliance and effectiveness of care.

[A new public governance of chronicity. New organizational structures for the vertical integration of care.].

This article compares three trials implemented in the Lombardy region with regard to the management of chronicity in general practice: first, the proactive taking in charge of chronicity; second, the Chronic Related Groups (CReGs); and third, the clinical government of Brescia's ATS. The analysis of the Lombardy reforms uses the cycle of public policies as an interpretative tool, with particular reference to the causal theories of the problem proposed by the policies, and to the strategies adopted to encourage change, understood as higher effectiveness and appropriateness in the treatment of chronic diseases with a high prevalence in the area.

[Peer review about gastro-esophageal reflux disease in primary care: epidemiology, diagnostic and therapeutic management].

Retrospective research carried out by 29 General Practitioners in their databases, in order to evaluate the prevalence of gastro-esophageal reflux disease in its different clinical outbreaks and the incidence of new diagnosis in the last quinquennium, the diagnostic approach through instrumental examinations (endoscopy) or empirical tests (PPI test), and the therapeutical aspects, in particular concerning the usage of PPI. The prevalence has been of 3.82%, while the data concerning the incidence have pointed out a progressive increase of the diagnosis in the last quinquennium, specially for the atypical outbreaks.