First EFIC® Symposium Societal Impact of Pain - SIP

Galileo Guidi
Dr. Galileo Guidi
Regional Commission for the Coordination of
the Action in the Fight Against Pain
Coordinator of the Interregional Work Group
on Palliative Care
Pain herapy and palliative care in Tuscany
In a 2001 modification to the Italian constitution,
the organization and administration of
health care services were delegated to the regional
governments. This change placed the
responsibility of pain therapy and palliative care
on the shoulders of the regional health care
system. The Tuscan region has confronted the
problem of pain therapy and palliative care in
its Regional Health Plans with a policy that furnishes
organisational guidelines for the services
that have been instituted in all the local health
authorities.
This policy for the development of a network
for the palliative care, including paediatric palliative
care, has been defined and adopted. This
course of action permitted not only the completion
of residential centres (hospices), but
also, in coherence with the national program
and financing, the integration with the territorial
home care services. Furthermore this policy
endorsed a project “Pain free hospital” that
has been introduced in all the hospitals in the
region. The regional government also instituted
a commission for the “Coordination of the fight
against pain”, composed of professionals, administrators
and public representatives with
the mandate to promote and coordinate all
the activities related to the fight against pain
and to monitor the indicators implemented by
the region as stipulated in the regional health
plan. The region has also adopted, within the
limits of the organizational autonomy foreseen
by national law, specific action to promote the
use of opiates.
The Tuscan Region has approximately 3,6 million
inhabitants, 12 local health authorities and
4 academic university hospitals.
In all the local health care authorities a functional
unit for palliative care has been activated.
Furthermore 22 hospices have been planned,
of which 17- including 1 paediatric hospice -
are operational with a total of 125 active beds.
There is also 30 active outpatient pain units in
the Tuscan region.
The region is also constantly monitoring the
indictors identified in the fight against pain in
collaboration with the Regional Health Agency
and the Sant’Anna School of Excellence. The
two indicators that form part of the regional
evaluation of the performance of the local
health authorities, and were identified, are the
consumption of opiates and the registration of
the parameters of pain in the clinical records
of patients admitted to hospital.
The results obtained in Tuscany can be summarized
as follows:
•The consumption of opiates (national data obtained
from SFERA) increased from 0.15
DDD/1000 inhabitants in 2001 to 4.15 in
2009. This represents an opiate consumption
of almost double the Italian national
average of 2.41 DDD/1000 inhabitants.
• In 2009 the per capita consumption of
morphine in Tuscany were 4.1 mg. A study
of the clinical records of the hospitalised
patients shows that pain parameters were
registered in 49.6% of the clinical records.
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