Dr. Paolo Banfi, Head of U.O.C. Riabilitazione Cardio-Respiratoria, IRCCS Fondazione Don Carlo Gnocchi, Milano

EV: What important changes should be highlighted in the management of rehabilitation projects one year after the outbreak of the pandemic?

PB: Substantial changes have been made, because rehabilitation, in our case, respiratory has changed its aspect, going more on the territory. For example, telerehabilitation has been introduced, that is, rehabilitation at a distance, in which a physiotherapist takes care of the patient’s rehabilitation. This is certainly very positive, because it allows us to monitor the patient constantly, day by day. In fact, the future sees us engaged in an evolution of rehabilitation, because the patient will be monitored for 24 hours, also thanks to an actigraph, in order to control his sleep and his movements, so it will be possible to see how he is and if, above all, he does the exercises that are given to him also to maintain his physical efficiency from a respiratory and muscular point of view. That has been the main change.

From a hospital point of view, IRCCS Fondazione Don Carlo Gnocchi is a “clean” Institute, so patients arrive here “clean”, negative for Covid-19. This is important, because from an organizational point of view it is extremely stressful. In fact, patients are swabbed both in the days immediately preceding admission and during the course of the same, after a period of isolation in quarantine of about a week. On day five, molecular swabbing is performed for verification of the possibility of placing the patient in a room of two.

EV: How have telemedicine projects changed, including in terms of application and use, with the COVID-19 emergency?

PB: COVID-19 has given telemedicine a big boost. Before it was, in my opinion, underutilized. Right now, however, I’m not saying it’s being used optimally, but it’s starting to appear in various hospital settings and in the territory.

EV: How is it possible to maintain the effectiveness and efficiency of care and, at the same time, preserve the empathy and humanization of care in telemedicine and telerehabilitation?

PB: Very pertinent question because there is no physical contact. Often and often physical therapists seek physical contact to achieve complete empathy with the patient. In this case, however, it is completely lacking because there is only telematic, visual contact. However, a lot has changed with the pandemic because the patient cannot hug or make contact with loved ones. At the very least, family members know where you are and how you are doing and that is very important. It’s very indicated that this audio-visual is supported by department staff. Better if it was a doctor, but also staff in contact such as nurses and physical therapists. This is to make it clear that your loved one is being followed, not a number left in a room. This is a way to empathize with the patient, but also with the family, with those around the patient.

EV: Are there any precautions and tips you feel like suggesting in this regard (also examples)

PB: First of all, it should not be a substitute for medicine. Telemedicine is important and will be increasingly important, but it should not become an alibi for not getting in touch with the patient. This has been coming out lately, because physicians are only contacting patients and family members through audio-video contact, not guaranteeing what is the usual contact with their doctor, something that some patients and family members complain about. So much so that some patients with Covid-19 are only followed by audio-video, when they would like the presence of the doctor.

EV: How can you literate even the most reluctant or for those who have the most difficulty using new technologies?

PB: Not everyone has the ability to have a tablet, although we provide it. But not everyone may be able to handle a tablet. So it is important that there is basic tutoring, that is, that they are followed step by step in the telematics intake. The telematics systems need to be simple, of the “click a button and I see you” variety.

EV: In your opinion, has the dialogue with community medicine in this year changed or remained unchanged?

PB: This will be a further evolution. In my dreams, I would like to see disease management systems where there is some sort of “operations centre” with experienced medical and nursing staff. I would abolish all those institutions where there is a pile of elderly people doing physical therapy, yes…but they are still institutionalized…those facilities that do activities, but without experiencing complete sociality. It would be wonderful to have a sort of “central”, for now let’s call it that even if perhaps it is not the most appropriate term, with small rooms that contain some patients and with a common room in which to socialize, meet exchange ideas and even dreams … because you dream even at that age! 

“Centres” where there is support for need and not institutionalization or systematic medicalization. It needs to be extremely lighter than institutionalization and, at the same time, overseen by a medical-nursing operations centre, with a nurse going to support this sort of community for therapies and needs and two or three OSS, depending on the number of inpatients, managing the needs of the patients. This needs to be open to family members. But this is really the future. 

EV: Are there any additional points to note about the topic you addressed?

PB: Emergency care, in some ways, has depersonalized us. Unfortunately, we still see patients abandoned in the ward…and it’s true, we’re still in an emergency and we don’t have as many hospitals and as many staff as we would like to have. However, we also don’t have the territory to adequately care for patients. We should learn from the pandemic, the care of the territory, which is always left to its own devices, abandoned. Many General Practitioners, unfortunately, are not able to manage patients or are not in a position to do so, so we still see therapies for Covid-19 invented or approximate, without following guidelines and what is known about the virus, -even if it is true that we know little about the virus- and therefore there are inappropriate personalization of care.

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