La fragilità e la vulnerabilità in sanità

Results of a research project aimed at identifying determinants of fragility and vulnerability in order to provide indications to health care providers for improving the situation in populations at highest risk. Aim. The aim of the study was to identify the determinants of inequality in the request for, or provision of, health care, in order to assist health care providers in the Lombardy Region. Methods. All the general practitioners of Milan's local health unit (ASL) were involved in the project. The study consisted of two phases: a "descriptive" phase to quantify the frequency of vulnerability and fragility, assessed with an 11-point numerical rating scale, and an "analytic" phase, in a selected sample of patients, to identify cases in which necessary screening and rehabilitation interventions were not carried out, defined as sentinel events. Results. The values of fragility and vulnerability indicated by the physicians for 10,798 patients recruited for the descriptive phase were, respectively, 3.7 and 3.1. For the analytical phase of the study, 794 patients were recruited, for a total of 261 sentinel events, of which the most frequent was failure to comply with rehabilitation after stroke. Conclusions. This study, due to the high level of participation, made it possible to obtain an estimate of the fragility and vulnerability of the population assisted by general practitioners in Milan and to study the prevalence of sentinel events on the lack of access to SSN services provided.