Publications by authors named "Roberto Toffanin"
Aims: To describe the impact of diabetes comorbidities on the health care services use and costs of a cohort of elderly patients with diabetes and high health care needs (HHCN), based on real-world data.
Methods: We focused on a cohort of diabetic patients with HHCN belonging to Resource Utilization Bands 4 and 5 according to the Adjusted Clinical Group (ACG) system. Their comorbidities were assessed using the clinical diagnoses that the ACG system assigns to single patients by combining different information flows.
Introduction: Patients with complex health care needs (PCHCN) are individuals who require numerous, costly care services and have been shown to place a heavy burden on health care resources. It has been argued that an important issue in providing value-based primary care concerns how to identify groups of patients with similar needs (who pose similar challenges) so that care teams and care delivery processes can be tailored to each patient subgroup. Our study aims to describe the most common chronic conditions and their combinations in a cohort of elderly PCHCN.
View Article and Find Full Text PDFObjectives: Our goal is to conceptualise a clinical governance framework for the effective management of chronic diseases in the primary care setting, which will facilitate a reorganisation of healthcare services that systematically improves their performance.
Setting: Primary care.
Participants: Chronic Care Model by Wagner and Clinical Governance statement by Scally were taken for reference.
Background: A growing presence of inappropriate patients has been recognised as one of the main factors influencing emergency department (ED) overcrowding, which is a very widespread problem all over the world. On the other hand, out-of-hours (OOH) physicians must avoid delaying the diagnostic and therapeutic course of patients with urgent medical conditions. The aim of this study was to analyse the appropriateness of patient management by OOH services, in terms of their potentially inappropriate referral or non-referral of non-emergency cases to the ED.
View Article and Find Full Text PDFBackground: Type 2 diabetes mellitus (DM) affects 382 million people worldwide.
Introduction: This study aimed at assessing whether telemonitoring (TM) of DM patients improves health-related quality of life (HRQoL).
Materials And Methods: As part of the RENEWING HEALTH project, 299 DM patients with HbA1c >7.
Purpose: The aim of this study was to describe the characteristics of patients admitted to an out-of-hours (OOH) service and to analyze the related outputs.
Setting: A retrospective population-based cohort study was conducted by analyzing an electronic database recording 23,980 OOH service contacts in 2011 at a Local Health Authority in the Veneto Region (North-East Italy).
Method: A multinomial logistic regression was used to compare the characteristics of contacts handled by the OOH physicians with cases referred to other services.
What determines frequent attendance at out-of-hours primary care services?
Eur J Public Health
August 2015
Background: A detailed description of the characteristics of frequent attenders (FAs) at primary care services is needed to devise measures to contain the phenomenon. The aim of this population-registry-based research was to sketch an overall picture of the determinants of frequent attendance at out-of-hours (OOH) services, considering patients' clinical conditions and socio-demographic features, and whether the way patients' genaral practitioners (GPs) were organized influenced their likelihood of being FAs.
Methods: This study was a retrospective cohort study on electronic population-based records.
Background: In Italian primary care, chronic heart failure (CHF) patients are mainly managed by general practitioners (GPs). However, there are few studies analysing CHF management challenges in primary care and identifying opportunities for improvement.
Objectives: To describe CHF care as implemented by GPs in the Veneto Region and to identify opportunities for improvement.
Introduction: The District care activities are often presented as number of patients, interventions or home visits. A better description should render more visible the persons and their clinical problems whose outcomes should be monitored.
Aim: To prospectically monitor the outcomes in a sample of home care patients followed for one year.
Unlabelled: Identifying a measure of community nurses' workload is complicated due to the difficulty of capturing and standardizing the nature of community nursing across health care settings.
Aim: Aim of this paper is to validate a workload/caseload nursing score for home care patients.
Methods: Patients of health care districts of Veneto region with at least two home care visits per month and a multi-dimensional and professional assessment were assesses with instruments used in routine care, adapted to the scope (a multidimensional assessment scale for frail elderly, that includes assessment of cognitive function, social support, mobility, functional status, health care needs); a list of patients needs.
Background: Many international guidelines address appropriateness, prescribing variability and drug-related expenditure in primary dyspepsia management.
Aims: To evaluate the impact on general practitioner (GP) practice and healthcare costs of a participatory intervention to modify primary dyspepsia and Helicobacter pylori (Hp) infection management, by standardised implementation of an international guideline in the local setting, through a prospective, controlled before-and-after study.
Methods: Primary dyspepsia management was monitored in the Local Health District of Padua; 63 of all 354 local GPs (total patient population: 82,284) took part in a primary-care improvement programme.