S60 - Libro Blu: a tool to coordinate Oncology practice and to rationalise resource employment

Abstract

Background: AOVV was born in 2003, covering a huge area with 4 hospitals, each working autonomously until then. The reform of Lombardy public health in 2015 changed the AOVV in ASST-VAL, including one more hospital. Such a broad area, with the conglomeration of different experiences, brought a need for harmonization of therapeutic choices to ensure all patients the same standard of care. Moreover, the increasing appearance of high cost drugs and the simultaneous restrictions in public health budget resulted in a need for a more rational allocation of expense. In this context, we took inspiration, and used its name, from “Libro Blu”, a tool previously adopted by IOSI. Material and methods: Our effort to coordinate Oncology practice resulted in the first edition of our “Libro Blu” in 2012. After periodic updates, in 2015 a major revision took place. Besides the updates in care of specific cancers, carried out by Oncology, Hematology and Radiation Therapy specialists, much attention has been paid to supportive care, involving consultants from Internal Medicine, Geriatrics, Endocrinology, Cardiology, Palliative Care and Psycho-Oncology. Recommendations in “Libro Blu” derive from Italian and international guidelines; after a thorough discussion in multidisciplinary meetings, they have been adapted to the specific needs of our local reality and approved after a final revision. Results: The implementation of “Libro Blu” resulted in a more consistent application of treatment protocols in our institution, ensuring all residents the same standard of care; notably, the facilitation of multidisciplinary discussions during this process allowed to raise the level of our cancer care, focusing both on treatment of the disease and on patients' needs in supportive care. Furthermore, establishing institutional guidelines for a rational use of high cost drugs allowed to reduce costs by about 400000 €/year. Conclusions: “Libro Blu” has allowed to establish a homogeneous standard of care in a broad area in which health professionals were previously working autonomously. The cost reduction deriving from our guidelines is particularly relevant in this moment, with Oncology facing the appearance of many high cost drugs in the context of a spending review that also involves the Italian health system. We think that “Libro Blu”, with the implementation of guidelines adapted to the specific needs of a local institution, could be reproduced in fields other than Oncology and in other local realities.