Implementing innovation in Primary Care: an Italian experience.

Background Since 2000, in Italy the General Practitioner (GP) Contract with the National Health Service has been changing towards increased participation of GPs in healthcare management to improve professional collaboration with other practitioners such as nurses and social workers. In Emilia Romagna (ER), a region in northern Italy, the Primary Care System has been reorganized with the institution of “Primary Care Units” (NCP) as main centres where GPs, nurses and other practitioners work together to deliver comprehensive healthcare outside the hospital. The aim of this study is to analyse number, function and organization of NCPs in ER two years after the introduction of this new model in 2006. Methods A web-based questionnaire was administered to Primary Care coordinators in the 11 Local Health Authorities. The questionnaire explored the NCPs development in terms of GP participation, clinical organization, integration with other healthcare practitioners and chronic disease management. Results At 30 June 2008 there were 214 NCPs and 94 % of total GPs (3013 on 3215) joined them; each NCP is composed of an average number of 15 GPs. In 159 NCPs the GPs meet periodically for training courses and strategic planning. Only in 62 NCPs are clinical activities performed in a unique place, while other GPs continue to see patients in their own offices. Only two NCPs provide nurse care. Chronic disease (Diabetes-COPD-Heart Failure) management is implemented in several NCPs with different strategies. Conclusions The case of NCPs introduction in ER is certainly a leading model in Italy for primary care management but more efforts are necessary to develop further in this direction. From our analysis, we found that most NCPs are at this moment just a formal aggregation and a low percentage of them are engaged in integrated clinical activities. New strategies for implementing this model are requested.