DESIGN AND ORGANIZATION OF AN INTERPROFESSIONAL NETWORK FOR HOME MANAGEMENT OF PATIENTS IMPLEMENTED DURING COVID-19 PANDEMIC AT ASL NAPOLI 2 NORD, SUITABLE ALSO IN THE DAILY MANAGEMENT OF CHRONIC PATIENTS LIVING IN THE SAME AREA

Abstract

Introduction:
The Coronavirus SARS-CoV-2 pandemic has altered the perception of the current National Health Service (SSN).
On one hand, the importance of a free and always accessible SSN for everyone has been strengthened. On the other hand, the fragility of a system with a too specialized and hospital-centered approach has become evident. In the pandemic context, the need to reverse the model by focusing on the needs of the community has become clear, with the main aim of promoting home-based management as much as possible for both chronic and acute conditions. This can be achieved through the creation of an integrated network involving all stakeholders in the care and assistance process, utilizing new technologies and telemedicine systems.
Materials and Methods: 
The aim of this activity was to delve into an integrated network model for home care of Covid patients, within ASL Napoli 2 Nord. This model utilizes interconnected and functionally integrated structures and nodes, with defined pathways and operational procedures based on dedicated telemedicine platforms. These platforms facilitate the comprehensive management and care of Covid-19 patients by all network stakeholders. Results were monitored using specific and dedicated indicators, collecting and analysing data from the period when the care of positive Covid patients began (November 2020), whose management did not require hospitalization.
Results:
From November 2020 to December 2021, the number of patients living in the ASL Napoli 2 Nord territory under home management included Home Health Care Units (USCA), non-ambulatory residential facilities undergoing non-pharmacological therapy (TNF), non-ambulatory vaccinated individuals receiving home vaccination, and vaccinated individuals in residential facilities, amounted to 38,223. Among these, 37.8% (14,476) tested positive for Covid.
The total number of accesses during this period was approximately 94,000, encompassing various types of care provided (TNF at home, TNF in facilities, home management of Covid+ patients, vaccinations in facilities, vaccinations at home for non-ambulatory patients). The shift has been significant, transitioning from managing the entirety of patients in hospitals to slightly over 4.5% of the total managed from December 2020 to December 2021.                    Conclusions:
The sensitivity of healthcare managers during the pandemic period translated into the realization that the focus of the National Health System (SSN) and the Regional Health System (SSR) needed to shift, directing efforts increasingly towards the implementation of local healthcare policies.
The high number of hospitalizations recorded was not solely due to the increased number of infections, but also to the challenges faced in providing home care. Creating, developing, and continually implementing an interdisciplinary and interprofessional network, coupled with the development of technological infrastructures and more, ensured the ability to address the emergency. This guaranteed that all citizens received the necessary care and assistance to navigate this historically critical and unexpected moment.
The reproducibility of this system assures the possibility of further network implementation, not only in emergencies but also for the daily management of chronic patients. Moreover, in a time when, among other things, Mission 6 of the National Recovery and Resilience Plan (PNRR) has allocated resources amounting to 15.63 billion euros to be invested in the healthcare sector, most of which are dedicated to revolutionizing our SSN and ensuring its greater efficiency and effectiveness in the territor.