Sip Italy

A new law “Policies to guarantee access to palliative care and pain medicine” - impact and perspectives

More information about services and aspects of palliative care of law 38 available on the website of the Italian Ministry of Health.

A short summary on Legge 38 you can find in this PDF.

Aims:

• Two integrated networks: palliative and pain medicine
• Selection of involved professionals
• Formation and education
• Funding of informational campaigns
• Institution of government-level overseeing
• Explicitly provides for the special needs of pediatric patients

Art. 1

This law grants citizens the legal access rights to palliative care and pain medicine

Art. 2 - Definitions

Palliative Care Interventions for patients and families in the presence of progressive disease with negative prognosis, not amenable to specific treatment.

Pain Medicine Diagnostics and therapeutics aimed at suppressing or controlling pain of any etiology.

Patient Person who suffers of chronic pain could evolve in illness and/or pain.

Art. 3 – Responsibilities

National Health Service Palliative care and pain medicine are priority objectives; implementation is required for access to complementary funding by the government.

Ministry of Health Defines guidelines for publicity, development and coordination of regional policies.

State-Regions Committee Verifies:

• Status of Implementation of the law
• Appropriateness of interventions
• Adequacy of available resources with respect to performance

Art. 4

€ 350.000 for information campaigns

Art. 5 State – Regions Committee

• Institutional Accreditation Criteria
• Staff Accreditation Criteria
• System coordination
• Reimbursement control
• Care homogeneity

Art. 6 – “Pain-free Hospital & Territory

€ 2.450.000 for staff education

Art. 7 Pain as vital sign: Regular assessment in patients’ medical records.

Pain management is the patient’s right, and the caring physician’s duty. Law requirements: written records of treatments and outcomes.

Art. 8 Educational Activities

• Medical school masters and post graduated masters (by the Ministry of Education and Research);
• CME for physicians and other staff;
• Compulsory internships/rotations (where applicable);
• Special education for volunteers and charities/NGOs.

Art 9 and 11 Process Control

National Commission monitors and reports to Parliament about:

• Network development
• Performance and Efficiency
• Education
• Public information
• Research
• Budget
• Technical reports by experts

Art. 10 . Simplification of prescription rules

No more special logs for oral or transdermal opioid formulations. Easier access to analgesics for acute and chronic outpatients. Encouraging some of Europe’s most reluctant prescribers

Art. 12

Budget for services: Ministry and State-Regions Permanent Conference: More or equal € 100 million/year taken from National Health Fund

This law has been so important and well done that it has been taken as a model to make the following declaration of Montreal:

“Access to pain management is a fundamental human right”