title: Analysis of patients' needs after liver transplantation in Tuscany: a prevalence study.
abstract: BACKGROUND
  The reorganization of the healthcare system in Tuscany aims at characterizing the hospitals as a place for the treatment of acute patients. This event, together with the improvement of long-term survival after orthotopic liver transplantation (OLT), calls for a management network able to ensure effective continuity of care for patient needs in the posttransplantation period.
  
  
  METHODS
  An observational study of prevalence has been carried out with the primary objective to evaluate patients' needs and criticalities both in routine daily life and in urgency in the posttransplantation period and the capacity of the regional health system to support them. A survey, using a semi-structured questionnaire consisting of 27 questions, was administered to all patients resident in Tuscany who underwent transplantation from 2000 to 2010. The survey tool assessed the following: socio-demographic data, personal, family and social difficulties, problems emerged in the clinical routine and urgency, resolution modality, relationships with the general practitioner and the referral specialist, and services the patients would appreciate receiving in their province of residence.
  
  
  RESULTS
  In the study, 346 patients matched the inclusion criteria of the study, 324 gave telephone consent to participate in the survey, and 225 responded (69.4%). The most frequent difficulties were as follows: depression (39.5%), difficulty in returning to work (29.3%), low income (22.6%), lack of self-sufficiency (22.6%), addictions (19.1%) (cigarette smoking 16.4%), 12.4% eating disorders, and 18.9% other difficulties (social isolation, absence of a family network, and so on). The main reasons for dissatisfaction were as follows: difficulty to obtain the required laboratory tests and lack of a reference structure at the local health facility. Few patients have a referral specialists in their area and most of them primarily refer to the Transplant Center even late after the procedure.
  
  
  CONCLUSIONS
  Early diagnosis of specific conditions (depression, addiction, and eating disorders) should be implemented in the follow-up period and services such as counselling, dietary support, rehabilitation, and social services should be provided locally. An integrated management system between the transplantation center and the local facilities (hospitals, general practitioners, primary care, and laboratories) should be implemented and referral specialized centers should be identified locally.
authors.affiliation: Liver Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy. e.stiavetti@ao-pisa.toscana.it
authors.forename: E
authors.initials: E
authors.lastname: Stiavetti
authors.forename: D
authors.initials: D
authors.lastname: Ghinolfi
authors.forename: P
authors.initials: P
authors.lastname: Pasetti
authors.forename: F
authors.initials: F
authors.lastname: Bocchi
authors.forename: F
authors.initials: F
authors.lastname: Filipponi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007558:Italy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D055815:Young Adult