The research conducted by the Piacenza doctor Daniela Petraglia with the aim of evaluating access to the emergency room and the Cau: «87% of accesses occur on the patient’s own initiative, often without any contact with the doctor and only in 2% of cases we do not respond»
«Inappropriate access to the emergency room: the role of General Medicine. Observational study in the province of Piacenza” is the research conducted by Piacenza doctor Daniela Petraglia34 years old, graduated in Pavia, specialized in Reggio Emilia and currently in service in Val Tidonetogether with medical colleagues from the province of Piacenza Mariacristina Arbasi, Matteo Carusone, Mauro Moretto and Elena Quarantelliunder the supervision of the Bolognese Marco Cupardo.
The study was published in the Simg journal (Italian Society of General Practitioners and Primary Care Doctors).
The objective of the research was to evaluate the inadequacy of access to the emergency room e to the Assistance and Emergency Centers (Cau) in the province of Piacenza, exceeding the limit represented by the sole reference to the triage code and analyzing the effectiveness of General Medicine as an access filter to these services.
Doctor Daniela Petraglia, how did this research project come about?
«The idea comes from a widespread feeling among family doctors: we often feel accused, by politics and the media, of being “unavailable” and therefore jointly responsible for the crowding of emergency rooms. Daily experience showed us a different reality and we wanted to verify it with data, overcoming the limiting interpretation of the triage code alone.”
How did you set up the study?
«We collected 300 visits to the emergency room in 77 days, referring to the patients of four general practitioners in the province of Piacenza. For each access we checked whether the patient had attempted to contact his family doctor first, whether there had been a consultation or visit (home or outpatient) and whether the doctor had advised his patient to go to the emergency room. We then asked general practitioners to express a judgment of appropriateness, case by case, regardless of the color assigned by triage.”
And what did you discover?
«The results show that 51% of accesses were judged inappropriate, with 87% occurring on the patient’s own initiative, often without any contact with the doctor. In cases where the general practitioner was involved, the appropriateness of access rose to 79%. Independent visits due to failure to respond by the family doctor within the time of admission to the emergency room were 2%. The study suggests that the patient’s failure to use the medical filter, rather than a presumed inefficiency of general medicine, is a determining factor for the improper crowding of emergency rooms. From here, the data disproves the narrative according to which emergency rooms fill up because the general practitioner does not respond.”
Why do citizens give up contacting their doctor?
«There is a lot of confusion, also due to the multiplication of services: emergency medical service, Cau, emergency room. In Emilia-Romagna the Cau should have represented an intermediate level, with basic diagnostics and nursing staff. In the province of Piacenza, however, they are often placed inside hospitals and end up being perceived as an extension of the emergency rooms. From here, many citizens no longer know which service is appropriate for their problem.”
Is the problem therefore also organizational?
“Yes. Creating more services without enhancing existing ones risks further fragmenting resources. The medical guards suffer from a serious shortage of personnel: many young people prefer the Cau and some offices remain uncovered. Paradoxically, increasing services has “crumbled” our strengths instead of strengthening them.”
What would it really take?
«General medicine has been asking for first-level diagnostic tools in clinics for years: basic ultrasounds, electrocardiograms… rapid tests. This would be enough to avoid many improper accesses. Rather than creating new levels of assistance, we should strengthen existing ones and clarify for citizens how to orient themselves. And our study shows how the majority of inappropriate accesses to the emergency room are due to the absence of a medical filter by the patient’s choice rather than to a real inefficiency of General Medicine, which instead, when involved, is able to exercise an effective filtering function by reducing inappropriate accesses”.
Your work also received an award.
«Yes, the Italian Society of General Practitioners and Primary Care Doctors awarded our practice last November 29th in Florence, on the occasion of the 42nd congress, selecting it among 66 works. It is an important recognition for a topic that concerns everyone: doctors, patients and the entire healthcare system.”
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