1. Dr.ssa Lucia di Furia Dirigente Medico PF ricerca sanitaria e biomedica, innovazione e formazione Pain relief and palliative care

2. Dr.ssa Lucia di Furia Dirigente Medico PF ricerca sanitaria e biomedica, innovazione e formazione Background to the project The project falls within the legal background of the Law n. 38 of the 15 March 2010 in particular with the: Regional Law 892 of the 20 June 2011 Regional Law 1512 of the 14 November 2011 Regional Law 17 of the 28 May 2012

3. Dr.ssa Lucia di Furia Dirigente Medico PF ricerca sanitaria e biomedica, innovazione e formazione Previous Legal Framework to Law n.38/10 Decree of the President of the Council of Ministers of the 29 of November 2001 (D.P.C.M. del 29 Novembre 2001): Health and social Home care, Residential, and semi-residential care, and hospital funds for home care to end of life patients define the Basic Level of Care (Livelli Essenziali di Assistenza (L.E.A.) Law 328/2001 and subsequent operational decrees: Regional guidelines to reach full integration among all interventions in the home care sector D.P.C.M. 20°January 2007 Minimal requirements for the Hospice.

4. Dr.ssa Lucia di Furia Dirigente Medico PF ricerca sanitaria e biomedica, innovazione e formazione LAW n. 38 of the 15°March 2010 All citizens have the right not to suffer unnecessary pain during their lifetime and at the end of life; Pain needs to be trated; The end of life period must be included in the care process. Main idea a.the dignity and authonomy of the patient must be protected withoput discriminations; b.the quality of life must be protected and promoted to the very end; c. the patient and their family must be supported through the health and social care.

5. Dr.ssa Lucia di Furia Dirigente Medico PF ricerca sanitaria e biomedica, innovazione e formazione Pain relief acute-primary care net Regional Law 892/11 Pilot Project – Pain Relief in Acute-Primary Care - (Progetto sperimentale Ospedale - Territorio senza dolore). Total funding 82.685 The Marche Region approved a pilot project finalised to create a structured pathway with the aim to improve pain relief care both in acute and especially primary settings. The Regional Law 1512 of the 14 November 2011 and the Regional Law 17 of the 28 May 2012 support the above project as well as other projects within the Law n. 38.

6. Dr.ssa Lucia di Furia Dirigente Medico PF ricerca sanitaria e biomedica, innovazione e formazione Pain relief acute-primary care net- Piloting a new care model Authors: Lucia Di Furia Luigi Nardi Alfredo Fogliardi Fabio Izzicupo Claudio Caputi Vincenzo Firetto Fulvio Borromei Edoardo Berselli

7. Dr.ssa Lucia di Furia Dirigente Medico PF ricerca sanitaria e biomedica, innovazione e formazione Pain relief acute-primary care net- Piloting a new care model Pain relief acute-primary care net – Aim The project aims to developing a care model which is able to guarantee, within the hospitals of the Marche Region, both a systematic and uniform detection of pain by the health professional involved (ability to methodically detect pain, ability to understand the level of pain) and consequently, when necessary, the administration of the appropriate and efficacious analgesic treatment. The project aims at improving the quality of life of patients who need any kind of treatment and who are in pain

8. Dr.ssa Lucia di Furia Dirigente Medico PF ricerca sanitaria e biomedica, innovazione e formazione The re-organisation and systematization of the current offer of services could guarantee easier access to the current health services, in particular reinforcing the pool of services for adults (and children) in the area. A new organisational model embedded in the area, will be developed. The level of care will be divided into three complementary sectors: the reference pain treatment centres (HUB), the outpatient analgesic treatment centre (SPOKE), and the GP surgeries. Pain relief acute-primary care net- Piloting a new care model

9. Dr.ssa Lucia di Furia Dirigente Medico PF ricerca sanitaria e biomedica, innovazione e formazione On the basis of the Regional Law n. 892 and application 17/2012 the Marche region has formed a Coordinating Group that, among other duties, is in charge of piloting the Pain Relief in Acute- Primary Care Project. The Coordinating Group must: Develop the new organisational model embedded in the area. The level of care will be divided into three complementary sectors: the reference pain treatment centres (HUB), the outpatient analgesic treatment centre (SPOKE), and the GP surgeries. Empower a designated structure to operate 24 hours a day to decrease the number of people who inappropriately access A&E; Pain relief acute-primary care net- Piloting a new care model

10. Dr.ssa Lucia di Furia Dirigente Medico PF ricerca sanitaria e biomedica, innovazione e formazione Support professional training to consider Pain as one of the Vital Parameters; Standardised the tool to evaluate the intensity of pain. Standardised the professional behaviours towards the evaluation and treatment of pain; Include the patient in the care plan, training him to be able to perform a verbal or written evaluation of pain through the Numerical Rating Scale (NRS); Train personnel to prevent under-estimation of pain, especially for people who suffer of cognitive deterioration; Pain relief acute-primary care net- Piloting a new care model

11. Dr.ssa Lucia di Furia Dirigente Medico PF ricerca sanitaria e biomedica, innovazione e formazione Guarantee the continuity of information and the informatization of the processes; Guarantee flow of information, communication, and awareness of the correct use of structures and care pathways; Pain relief acute-primary care net- Piloting a new care model

12. Dr.ssa Lucia di Furia Dirigente Medico PF ricerca sanitaria e biomedica, innovazione e formazione Methodology The project involves a methodological-managed and clinical-care study to be piloted in a so called Area Vasta, a well-defined area, which is representative of the critical points and the opportunities of our local healthcare system. Following evaluation of the pilot project, the necessary modifications will be made, before extending the operating system in the entire regional area. Pain relief acute-primary care net- Piloting a new care model

13. Dr.ssa Lucia di Furia Dirigente Medico PF ricerca sanitaria e biomedica, innovazione e formazione Role of The health professionals The health professionals observe and document the level of pain of the patient, as the V vital parameter, using a standardised tool, validated to evaluate the intensity of pain. Pain relief acute-primary care net- Piloting a new care model

14. Dr.ssa Lucia di Furia Dirigente Medico PF ricerca sanitaria e biomedica, innovazione e formazione The project gets its realization in controlling pain, which is often associated to other symptoms. It includes the take-off of procedure pain management protocols for adults and children within the hospital. The need to safeguard both adult and children patients forces the Region to define a project which will identify an organizational pathway able to improve pain relief treatment both in acute and especially in primary care. Pain relief acute-primary care net- Piloting a new care model

15. Dr.ssa Lucia di Furia Dirigente Medico PF ricerca sanitaria e biomedica, innovazione e formazione Thank you