[Project of contrast to avoidable mortality in a metropolitan local health authority]. / Progetto di contrasto alla mortalità evitabile in una asl metropolitana.

INTRODUCTION: The avoidable mortality (ME)represents the share of deaths that occurs at an early age (0-74 aa) for causes that cannot be faced by means of public health or health care measures. The work develops a strategic intervention plan aimed at the reduction of ME by identifying local priority actions based on epidemiologic and social-health data. METHODS: a working group among the Department of Prevention, Health Information Systems and Health District was set up. The databases used were: "State of Health Lazio" of the Department of Epidemiology of the Lazio Region; ASL Roma 2 local health data on general mortality (2014-2016) and the local health profile of the surveillance systems "OKkio alla Salute", Passi and HBSC Lazio. The analysis results in an estimation of Asl Roma 2's data and in a comparison of this data set with the regional level of three indicators: avoidable mortality, prevalence and incidence of chronic diseases and lifestyle profile. RESULTS: in the three-year period (2014-2016) there were about 1,900 avoidable deaths per year; in the ASL Roma2 the ME represents about 16% of the total mortality and 60% of them are borne by the male sex. 51% of ME concerns cancer, 27% is linked to cardio-vascular diseases, 10% to trauma and poisoning. A preliminary comparison of standardized ASL Roma 2 rates of prevalence and incidence with regional values shows higher figures for some pathologies in ASL Roma 2: COPD prevalence (114 vs 107), breast neoplasia incidence (174 vs 153), incidence of lung neoplasia (71 vs 65). Prevalence and incidence of chronic diseases at the District level are not entirely consistent with the regional values according to a two level score. Incorrect lifestyles are widespread in at least 30% of the population and are more frequent in families with low educational level and with reported economic difficulties. CONCLUSIONS: despite the intrinsic limitations of a precise estimate of the data and the possible biases in a process of inference, the method has allowed to identify the priorities to assign in primary and secondary prevention interventions planning and for the improvement of health care; this analysis has been structured in a three years Local Strategic Plan to face the ME and was articulated in general and operational objectives and actions measured by indicators both process and, where possible, outcome evaluation.

[Pharmaceutical expenditures in the different municipalities of Rome (Italy): impact of socioeconomic conditions of the resident population]. / Spesa farmaceutica territoriale nelle Aziende Sanitarie di Roma Capitale: impatto delle condizioni socio economiche della popolazione residente.

Pharmaceutical expenditure is a cost item that is monitored continuously, to verify the appropriateness of prescriptions, the good use of available resources and to contain costs. However, socioeconomic differences in the population affect health conditions and consequently health expenditure. A comparison of socio-economic determinants and per-capita pharmaceutical expenditure in the different municipalities of Roma Capitale (Capital city of Rome, Italy) indicates that higher expenditures occur in areas characterized by lower socio-economic conditions.

Pharmacoeconomic impact evaluation of statin adherence in high-risk unselected post myocardial infarction population: an administrative database-guided analysis.

BACKGROUND: The compliance to statins in secondary prevention is very low, increasing health-care costs principally for rehospitalization. OBJECTIVES: To evaluate the cost of lack of persistence to statin therapy together with identification and cost-estimation of poor compliance. METHODS: Retrospective observational study starting from administrative database analysis of statin prescription after myocardial infarction. RESULTS: Among 463 patients enrolled, 25.1% were never treated, 70.8% received statins regularly; 14.9% received only 1-2 prescriptions (spot prescription), and 12% were occasional users. Among the 288 nonoccasional users, we found a compliance rate of 80% only in the 59.7%. The cost analysis shows that 59.787,72 euros (23.4%) have been spent for patients with compliance of less than 80% (ineffective adherence). CONCLUSIONS: As the lower compliance affects the health-care costs, the identification of occasional users and spot prescriptions of the nonoccasional users, has a potential role in reducing medical expense with limited increase in costs.

[A system of indicators for identifying the specific healthcare needs of communities by large health departments]. / Un sistema di indicatori distrettuali come strumento di lettura di una realtà aziendale complessa.

Clinical governance of healthcare and community services by healthcare organizations requires the use of validated tools for identifying the specific healthcare needs of the local population. The population served by a local health organization may be large and although data regarding this population as a whole is useful for a preliminary evaluation, it may be too generic for an accurate estimation of the healthcare needs at the district level since different districts may face different challenges and have profoundly different realities. In this context, it can be strategically useful to use a system of indicators targeted at districts, the latter regarded as the basic unit of the health care system and characterized by a relatively constant structure and size.A set of district indicators has been developed and adopted by a local health authority in Rome (Italy) "ASL Roma B", as part of a collaborative project with the Public Health Agency of the Lazio region. In this paper, we present the main results of the first four years of implementation of the system (from 2007 to 2010).The data shows that even within a metropolitan health organization serving an apparently homogeneous population, health needs, provision of services and outcomes may vary greatly between different districts suggesting the adoption of diverse operational strategies.

[Indicators of statin use as a model for qualitative evaluation of chronic disease management in the Local Health Unit Roma B]. / Indicatori di farmacoutilizzazione nel trattamento con Statine come modello per la valutazione qualitativa nella gestione delle patologie croniche nell'Asl Roma B.

In chronic diseases the adherence and persistence to therapeutic treatments are often lower than guidelines said. This leads to a worse therapeutic effect of the treatments and to a misuse in healthcare costs. Our study evaluates the impact of a pharmacoutilization analysis model, derived from the administrative database of the Local Health Unit Roma B. In particularly we calculate some indicators of adherence, persistence, occasional treatment and switch in patients on statins secondary prevention treatment (patients discharged from Hospital with Acute Myocardial Infarction diagnosis). The model that we developed would be successfully used in the cost-effective analysis of other drugs.

[Defining a set of indicators for the evaluation of healthcare needs and of the performance of local health authorities]. / Costruzione di un set di indicatori per la valutazione dei bisogni sanitari e della performance dei distretti.

A set of indicators for assessing healthcare needs and evaluating healthcare services are needed. This paper presents a set of indicators for evaluating healthcare districts, defined by a local health authority in the city of Rome. The set of indicators was developed by selecting 11 areas of interest and assigning to each area indicators that would allow an evaluation of its main functional aspects. Overall, 99 indicators were chosen and listed under one of two sections: basic and specific indicators. Annual measurements of the indicators is performed and a study will be conducted during 2010 to evaluate the system of indicators.

[Feasibility of behavioural interventions for tobacco smoking cessation in routine general practice]. / Intervento motivazionale del medico di medicina generale nel processo di disassuefazione dal fumo di tabacco.

The aims of this study were: 1) to evaluate a training course on smoking cessation techniques offered to general practitioners of the RMB Local Health Unit (Rome, Italy) 2) to evaluate the feasibility of delivering brief counseling interventions during routine primary care practice and 3) to evaluate factors associated with modification of smoking habits. In total, 166 GPs participated in the training courses. Of these 60 GPs (36.1%) voluntarily agreed to take part in the study. A total of 3280 patients were enrolled and given a brief counseling intervention ("ask-advise"). Six months later the same patients were asked to complete a questionnaire, 24% responded. Approximately 24% of those who responded had quit smoking and over 43% had either reduced the number of cigarettes or attempted to quit. Of the subjects who modified their smoking behaviour (quit, attempted to quit, or reduced the numbers of cigarettes smoked) following the "ask-advise" intervention, 10% had also used drug therapy, while approximately 4% did so only with their doctor's assistance. Smoking cessation interventions incorporated into routine consultations in general practice are feasible and relevant from a public health perspective.

[An intervention model for smoking prevention strategies]. / Strategie di prevenzione del tabagismo:un modello di intervento.

Tobacco smoke represents the main cause of preventable morbidity and mortality in Western countries: in Italy, approximately 85.000 persons die each year because of smoke-related illnesses. Starting from the objectives defined by the 2001/2003 National Healthcare Plan, the Department of Prevention of the "Roma B" Local Health Unit elaborated a three-year project for the fight against tobacco smoke. The general objectives of the project are: to prevent young people from starting to smoke, to promote stop-smoking initiatives (with the involvement of General Practitioners) and to protect non-smokers from passive smoking (in the context of a smoke-free health facilities program). A special technical-scientific committee was set up to evaluate the effectiveness of the smoking prevention interventions.