Summary

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. 

2007-2007

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

Partecipants and Collaborations

Coordinators

Regional Study group

Rubin Renato 
Regione Veneto: coordinatore di progetto 

Componenti Parte Pubblica

Ambrosini Venceslao 
AULSS n. 5 - Ovest Vicentino 
Briguglio Emilio 
AULSS n. 15 - Alta Padovana 
Cereser Gianfranco 
AULSS n. 10 - S. Donà di Piave 
Cerulli Annalisa 
AULSS n. 16 - Padova 
Rosito Alba 
AULSS n. 4 - Thiene (referente per revisione linee guida asma) 
Ciccarese Mauro 
AULSS n. 40 - Thiene 
Pecere Giampaolo 
AULSS n. 18 - Rovigo 
Salzani Fulvia 
AULSS n. 8 - Asolo 
Saugo Mario 
AULSS n. 4 - Thiene (coordinatore scientifico) 
Toffanin Roberto 
AULSS n. 16 - Padova 
Vanzelli Alessandro 
AULSS n. 8 - Asolo 
Zanardi Oliviero 
AULSS n. 21 - Legnago 

Componenti Parte Sindacale

Savastano Renato 
AULSS n. 6 - Vicenza FIMP 
Spanevello Valter 
AULSS n. 6 - Vicenza FIMP 

Componenti Esperti

Baraldi Eugenio 
Università di Padova 
Boner Attilio 
Università di Verona 
Rossetti Flavio 
AULSS n. 17 - Este; Direttore Dip. Materno Infantile dell'Ospedale di Monselice 
Zorzi Carlo 
AULSS n. 15 - Alta Padovana; Direttore Dip. Materno Infantile dell'Ospedale di Camposampiero 
Mazzoleni Stefano 
AULSS n. 15 - Alta Padovana

Coordination of the monitoring system

Mario Saugo 
Osservatorio Epidemiologico, ASL 4 di Thiene 

Luigi Cantarutti 
PLS, Società Servizi Telematici 

Carlo Giaquinto 
Dipartimento di Pediatria, Padova 

Giampiero Chiamenti 
PLS, Verona 

Franco Pisetta 
PLS, Padova 

Renato Rubin 
PLS, Vicenza

Partecipants

All family paediatricians who participate in the “Cure Primarie” project

AULSS 5 – Ovest Vicentino
Amanatidu Eleni, Bonati Saverio, Cracco Franco, Danda Riccardo, D’Avino Andrea, Diana Rosalia, Ferrari Giulio, Foglia Paolo, Fortunato Elena, Fraccarolo Antonio, Fusco Fabrizio, Gallo Roberto, Mascarello Nicoletta, Prandoni Stefano, Sambugaro Daniela, Sartori Michele, Sassolino Stefania, Tegazzini Aldo, Trevisan Maria Concetta, Usai Aurora. 

AULSS 8 - Asolo
Bonaiuto Francesco, Bonato Giustina, Callegari Miriana, Carnazza Silvia, Chiavelli Goffredo, Comis Aldo Stefano, Dalla Pozza Daniela, Dallago Lorenzo, Dell’Antonia Fabio, Favilli Tania, Gaiotti Patrizia, Gobbi Patrizia, Macchia Maria Rosaria, Mastroprimiano Silvana, Montini Camilla, Murgia Loredana, Orlandi Alberto, Palmieri Carmela, Pietrobon Ferruccio, Pomiato Franco, Seminara Maria Elena, Toffol Giacomo, Tringali Gaetano, Zini Alessandro, Zuccolo Luisa. 

AULSS 10 – San Donà di Piave
Baiocchi Donatella, Balliana Franco, Barbazza Maria Carolina, Belluzzi Gabriele, Bompan Maria Rita, Bonaventura Diana, Bozzato Mara, Cavedagni Monica, Danieli Daria, Faccioli Giuseppina, Gennari Francesca, Melchiori Wally, Montini Caterina, Pandolfini Vittorio, Ricci Maria Carla, Scalambrin Ave, Surace Santina, Veronese Marino. 

AULSS 15 – Alta Padovana
Bignotti Laura, Caielli Lorenza, Calore Annamaria, Castaldo Massimo, Cavagna Guido Valentino, Chirco Maria, Cirillo Armando, Degan Emanuela, Ferretti Mauro Gabriele, Filippi Valeria, Gallo Giovanni, Gardin Lia Vittoria, Lista Cinzia, Luise Francesco, Macropodio Nadia, Menara Mariano, Milani Massimo, Nardi Elisabetta, Nardini Flavia, Naso Immacolata, Pasquato Stefano, Saretta Luigi, Schievano Paolo, Stocchero Lorenzo, Toderini Luisa, Zampieri Maurizio. 

AULSS 16 – Padova
Bellavere Donatella, Bernuzzi Marco, Bertoli Stefania, Bucolo Carmelo, Bussi roberto, Cangeni Ninfina Maria, Cantarutti Luigi, Criconia Carla, Dal Zio Maria, De Marchi Annamaria, Del Torso Stefano, Delise Alessandra, Denes Franca, Drago Stefano, Falconi Paola, Felice Michele, Ferrarese Marta, Formentin elisabetta, Frescura Carla, Fumaneri Fabrizia, Giancola Giuseppe, Giaretta Letizia, Granatiero Lorenza, Lovison Loredana, Luchelli Roberta, Manni Cecilia, Matttiazzo Paola, Pavan Anna Morena, Perin Stefania, Perri Vera, Pisetta Franco, Pristinger Delia, Puppin Giuliana, Ruggiero Annalisa, Sambo Luigi, Sidran Maria Pia, Turio Chiara, Verri Viviana, Vozzi Aldo, Zanoni Laura, Zilli Caterina. 

AULSS 18 – Rovigo
Alberti Elsa, Baraldi Lauretta, Caserta Antonio, Chiriacò Maria Antonietta, Destro Florinda, Frignani Graziana, Katende Mulopo, Meo Antonio, Nicolini Piero, Pasqualini Massimo, Rossi Valeria, Siciliano Cinzia, Siviero Beatrice, Sortino Paolo, Zuccolo Anna Maria. 

AULSS 21 – Legnago
Baraldo Robertino, Bawab Ibrahim, Benini Adriana, Bonoizzato Maria Cecilia, Costantini Emanuela Paola, Fabriano Giavanni, Miglioranzi Giampaolo, Saldi Mauro, Soffiati Francesco, Vighini Mirella.

Collaborations

Data Monitor

Antonio Scamarcia 
Società Servizi Telematici, Padova

Computer-related Assistance

Alessandro Zandarin 
Società Servizi Telematici, Padova

Pubblications