Management of an Integrated Care Pathways (ICPs): an Italian Study

Background
 The World Health Organization defines chronic disease as long duration and generally slow progression disease, with a continuous treatment over decades. The management of such diseases is complex, as the aim of treatment is not cure, but maintenance of a good quality of life and prevention of possible complications. Cardiovascular diseases are the leading cause of death worldwide (18 million deaths per year) and hypertension remains the largest preventable cause of cardiovascular disease globally. In Italy, the prevalence of hypertension was of 31.1%. The goal of antihypertensive therapy should be to reduce blood pressure back to physiological levels or to a range of values identified as targets. The National Chronicity Plan identifies an Integrated Care Pathways (ICPs) for several acute or chronic conditions, at different stages of disease and care levels, in order to optimize the healthcare processes.

The aim of the present work was to perform a cost-utility analysis of management models of Hypertension ICPs to assist frail patients with hypertension following the National Health Service (NHS) guidelines in order to reduce morbidity and mortality rates. In addition, the paper emphasizes the importance of e-Health technologies for the implementation of chronic care management models based on the Chronic Care Model (CCM).

Materials and Methods
 The management of the health needs of frail patients in a Healthcare Local Authority finds an effective tool in the Chronic Care Model, involving the analysis of the epidemiological context. Hypertension Integrated Care Pathways (ICPs) includes a series of first-level laboratory and instrumental tests necessary at the beginning of the intake, for accurate pathology assessment, and annually for adequate surveillance of the hypertensive patient. For the cost-utility analysis were investigated the flows of pharmaceutical expenditure for cardiovascular drugs and the measurement of the outcomes of the patients assisted by the Hypertension ICPs.

Results
The average cost of a patient included in the ICPs for hypertension is 1636.21 euros/year, reduced to 1345 euros/year using telemedicine follow-up. The data collected by Rome Healthcare Local Authority on 2143 enrolled patients allow us to measure both the effectiveness of prevention and the monitoring of adherence to therapy and thus the maintenance of hematochemical and instrumental tests in a range of compensation such that it is possible to impact on the outcomes, resulting in the 21% reduction in the expected mortality and the 45 % reduction in avoidable mortality due to cerebrovascular accidents, with related impact on potential disability. It was also estimated that patients included in ICPs and followed by telemedicine compared to outpatient care, obtained a 25% reduction in morbidity, with greater adherence to therapy and better empowerment results. The patients enrolled in the ICPs who accessed the Emergency Department (ED) or hospitalization presented adherence to therapy in 85% of cases and a change in lifestyle habits in 68%, compared to the population not enrolled in the ICPs, which presented a 56% adherence to therapy and a change in lifestyle habits of 38%.