2004 – 2007
In 2004, the Veneto region with some local health authorities (ASL) started an experimental project for the monitoring amongst family paediatricians of the implementation of guidelines put in place by the local health authorities for the management of the following pathologies:
-Acute otitis media, exudative otitis media, myringitis (ASL 5, 8, 10)
-Acuto pharyngotonsillitis (ASL 5, 8, 10, 18)
-Asthma (ASL 16 e 21)
-Febrile infant without localising signs (ASL 16 e 21)
-Broncopneumonia (ASL 21)
-Urinary tract infections (ASL 21)
The coordination of the monitoring of the clinical epidemiological indicators was assigned to the epidemiological department of the ASL 4. They then used SoSeTe for data collection, validation and analysis.
As the vast majority (75%) of the participating paediatricians are computerised, the data collection system was created on electronic files and data was to be sent via internet to a central server at the Società Servizi Telematici.
For paediatricians not having the possibility to use this electronic system, or who so preferred, a paper based system was created with all the necessary details for each pathology. Such data was later converted into electronic files to allow all data to be managed in the same way.
A report was produced every six months, after the data for that period had been validated, in which the aggregated data was described as prescribed in the regional project.
The results (data was collected on over 20,000 cases – see report) show a positive outcome of the project, especially considering that 90% of the participating family paediatricians sent data regularly. The number of cases described per pathology were very high and represent a unique set of data allowing the evaluation of the impact of the implementation of the guidelines on the pathology in question.
From the data collected, one can see the difference between the formal undertaking to part-take in the project and the actual implementation of such guidelines. Where the guidelines were applied, they resulted in a more appropriate diagnostic and prescriptive management.
Preliminary data collected in the pilot study suggest that a correct implementation of the guidelines may bring about an improvement in resource utilisation and an optimisation of services given to the child.
Based on the results of these first two years, the Veneto region with the local health authorities and the family paediatrician syndicates decided to continue in the process of guideline implementation and to extend the project to other health authorities.
In particular, the asthma guideline was to be implemented at a widespread regional level.
The new regional agreement for family paediatricians stipulates that all local health authorities (ASL) apply the asthma guidelines. All paediatricians adhering to the project have to send information for the monitoring of guideline implementation.
The guidelines have two principal objectives:
- Correct diagnosis of asthma cases
- Active follow-up planning for asthmatic children to decrease the risk of exacerbations.
To evaluate the impact of guidelines on the outpatient management of asthma, the software (based on JuniorBit software) will collect indicators for clinical epidemiological monitoring defined by the Regional Study group and which can be thus simplified:
- Identification and monitoring of children with asthma
- Estimate of the incidence and prevalence of paediatric asthma in the community
- Proportion of children with asthma with the active follow-up programme
- Proportion of children with well controlled asthma and correct treatment
- Proportion of children with asthma with allergy testing and spirometry carried out on the family paediatrician’s premises.
- Proportion of children with asthma treated with specific drugs (salbutamol and/or steroids)
Ad hoc files will be created to add to the Junior Bit software that will allow the evaluation of the level of good asthma control and proportion treatments prescribed according to the approved guidelines