Abstract
Chronic pathologies increase constantly as the average life period lengthens. In particular, it has been observed a significant increase in cardiovascular diseases. In the Lombardy Region, this issue has been faced by developing a project for those who are suffering from both single or multi-pathologies. This project called PIC, which stands for "treatment of chronic patients" in Italian, is improving patient adherence to therapies. To meet the needs of these patients, Lombardy's family doctors have joined in cooperatives in order to better help chronic patients by providing a service center and the necessary tools for drafting a detailed individual care plan. The individual care plan is a digital document including a customized planning for each patient. This allows a better monitoring, which results in an effective treatment course.
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