Innovation: Houses of Health
Emilia-Romagna, Italy
AAI Domain: Independent, healthy and secure living (improving access to health care services)
Active and healthy ageing occurs over the whole of the life course and is based on a partnership between individuals and communities with public services along with the private sector and third sector non-governmental organisations. Health care services are an important component of the process of active ageing although they need to be the right service in the right place at the right time in order to be effective for people at an affordable cost, regardless of the method of financing that is used. Many health care systems have a division between primary care provided by general practitioners and secondary care provided in hospitals with the former being relatively low cost and the latter being comparatively high cost, especially when treatment involves an admission.
In 2012 the northern Italian region of Emilia-Romagna introduced a network of 60 Houses of Health, effectively polyclinics, to improve access to primary care for people with chronic conditions such as type 2 diabetes or chronic obstructive pulmonary disorder (COPD) without requiring hospital based treatment. Houses of Health offer primary health care services provided by general practitioners and nurses but also offer a wider range of services for children and parents (paediatricians and midwives) as well as rehabilitation gyms, specialist medical services and access to social service professionals.
There are small, medium and larger Houses with the range of services varying according to size and location and they are usually open 24 hours a day. The Houses also provide important public health functions focusing on prevention and promotion of good health through lifestyle advice for both particular groups and the whole population. For example, they offer some cancer screening provision, vaccinations for children to prevent influenza among older people and interventions to reduce cardio-vascular risk among people identified as being at elevated risk.
Houses of Health also provide advice and support on healthy lifestyles such as stop smoking services and physical activity on prescription programmes. They also have ‘opportunity maps’ for citizens to highlight opportunities and possibilities that would promote health and well-being such as healthy lifestyle community projects and voluntary groups for particular groups of patients.
Improved access to ‘primary health care services plus’ is particularly beneficial to groups who may find it difficult to access health care such as children, older people, immigrants and people with common mental health issues. Consultations with GPs for anxiety and depression are commonplace and the Houses of Health can provide a better model of stepped care between primary and secondary sources. Many also operate projects for adolescents to reduce risky behaviour with alcohol, taking illegal drugs or starting smoking as well as advice on the prevention of obesity, communicable diseases and protection against abuse.
In relation to active ageing, Houses of Health are an innovative form of health care provision within the Italian system that provide improved access to services for people across the life course. The emphasis on improving access for people with long-term conditions, prevention programmes for major risks to health and well-being and the promotion of lifestyle advice are all commendable.