[The best place for the hospitalized kidney patient: internal medicine or nephrology? Comment].
Proposals of new organizational models and awareness of the limits of the available resources are leading to certain changes in the hospital organization in some Italian regions. These changes consist mainly of the creation of large departments of internal medicine divided into sections according to the different levels of care, and the abolishment of specialty divisions like nephrology. When this happens, it can be hypothesized that specialists will become mere consultants and will no longer take direct care of the patient. This already happens in many countries but is a novelty in the Italian medical system. This paper comments on the pros and cons of the new model as seen by an internist and a nephrologist in two papers in this issue of the journal. When addressing this subject, the main factors to be taken into consideration should be 1) long-term care for patients with chronic disease; 2) coordination of admissions for acute and chronic disease; 3) hospital size. It is to be hoped that the efficacy of the new models will be judged not only by managerial and economic criteria, but also using indicators of clinical outcome.
Cancarini
Giovanni
G
Direttore, Sezione e U.O.C. Nefrologia, Presidio di Brescia, Università e A.O. Spedali Civili, Brescia. gcancarini@alice.it
D002983:Clinical Competence / Q000191:economics / Q000592:standards*; D006436:Hemodialysis Units, Hospital / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007297:Inpatients; D007388:Internal Medicine / Q000592:standards; D007558:Italy; D007674:Kidney Diseases / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000628:therapy*; D008134:Long-Term Care / Q000191:economics; D017146:Models, Organizational; D020380:Needs Assessment; D009398:Nephrology / Q000592:standards; D017063:Outcome Assessment, Health Care / Q000191:economics; D010819:Physician's Role; D016019:Survival Analysis