[Analysis of national information systems for the provision of outpatient contracted specialist care at community level in Italy].

BACKGROUND: Outpatient Contracted Specialist (OCS) healthcare, together with General Medicine and Pediatrics, is one of the basic elements of community healthcare granted by the Italian National Health Service (NHS). In 2022, an important reform of community healthcare (Italian Ministerial Decree No.77) was introduced, strengthening the role played by OCS in Community Homes, home care and nursing homes. However, unlike all other community health workers, no staffing or hours' provision standards have been established for OCS. Besides this, ministerial reports state only few and different data on the amount of OCS care actually provided in community settings. OBJECTIVES: to analyse Italian National Information Systems methods and variables for measuring OCS healthcare provision in community settings. METHODS: starting from the sources used by institutional national reports on healthcare workforce and resources, the national information systems containing health workforce-related variables were selected and their latest regulations and technical documentations were analysed. Data collection methods, variables for OCS and their survey criteria were therefore identified. A comparison among the systems was then made through a common matrix. Similarly, regulations and technical documentations previously adopted by the same systems were also reviewed. RESULTS: the national information systems containing variables on healthcare workforce are: the annual surveys established by the Italian Ministerial Decree of 19.03.1988 and subsequent amendments, the Annual Account survey (AA), the Report attached to the AA, and the Interregional Agency for contracted health professionals survey (SISAC). Only two of these systems were found to collect data on OCS: the SISAC survey and the AA. The OCS variables collected were the total number of OCS medical doctors (collected by SISAC and AA), stratified by gender and specialization (by AA only), and the number of overall hours of care provided (collected by SISAC only), which is not stratified by specialization. Data reported for the single common variable (total number of OCS doctors) were always different in the two systems, with AA data constantly lower to those of SISAC between 29.12% and 41.37% in all surveys performed from 2019 to 2022. The classification system for medical specialty used by AA was however different from that used by SISAC which also includes OCS doctors working in penal institutes and OCS dentists. No variable dedicated to the number of hours provided per specialization was found and none of the systems was able to distinguish between community or hospital setting. CONCLUSIONS: the analysis highlights a major weakness in current national information systems in properly measuring NHS provision of OCS care in all settings. Currently available variables, besides having different data according to the sources, appear to be of little public health use, even for the development of the new community healthcare model as envisaged by Ministerial Decree No. 77. To avoid the risk of a silent erosion in the Italian NHS public provision of community specialist outpatient care and its replacement by the private sector, the following actions seem to be needed: the adoption of variables for monitoring provided OCS hours by specialization at health district level, the introduction of hours' provision standards for community specialist outpatient care and the inclusion of OCS in staffing need plans.