A DIsaster Preparedness Capacity Development Program for Family and Community Nurses (DiPP-CoN) to facilitate access to care and reduce avoidable hospitalizations during disasters

This project aims to foster primary healthcare (PHC) disaster preparedness through the role of Family and Community Nurses (FCN; Infermieri di Famiglia e Comunità), specifically targeting continuity of care during disasters. FCN are chosen as they have a pivotal role in the Piano Nazionale di Ripresa e Resilienza (PNRR) as well as during disasters, when resources are stretched and vulnerable groups left behind. The Health Emergency and Disaster Risk Management Framework lays the foundation for the health management of disasters and emphasizes the need for communities and the PHC system to be prepared for disasters. A prepared PHC ensures continuity of care during disasters and guarantees access to care for vulnerable populations, ultimately enhancing community disaster preparedness. The Italian response to the COVID-19 pandemic shed light on a poorly prepared PHC system, unable to properly function when this was most needed. This triggered a process of reform of PHC, supported by the PNRR, which aims to promote the proximity healthcare network via the establishment of community health infrastructures (Case della Comunità, Ospedali di Comunità), the relevance given to FCN, and a strong emphasis of the implementation of IT technologies. All this is rooted in the principle of bringing care closer to people, to contain avoidable hospitalizations and improve access to care. Such a PHC reform (Minister Decree 71, under discussion) is far-reaching but, despite being enacted on the brink of the COVID-19 pandemic, it neglects PHC disaster preparedness. It therefore remains unclear how PHC can cope with future disasters without failing to guarantee continuity of care and leaving vulnerable groups behind. The analysis of Ambulatory Care Sensitive Conditions (ACSC) may inform on the performance of PHC during disasters and on which groups are most at risk for avoidable hospitalizations, pointing out possible PHC access constraints and providing the knowledge base for strengthening PHC disaster preparedness. ACSC are health conditions for which adequate, timely and effective outpatient care can prevent hospitalization (hence the reference to “avoidable” hospitalizations). In view of this, a high number of hospitalizations may indicate poor management of ACSC at the PHC level. By employing both quantitative and qualitative methodologies, and a participatory approach, this project aims to: 1) explore the trend of hospitalizations for ACSC during the pandemic in Piedmont; 2) identify determinants of hospitalizations for ACSC during the pandemic, as well as any individual- and PHC-level best practices for better ACSC care during disasters; 3) create a scalable capacity development intervention, a multi-phase, collaborative process that improves the abilities of the PHC system to perform better during disasters through the strengthening of FCN disaster preparedness capacities; 4) pilot the intervention in the Vercelli province and perform process evaluation.