The challenge of community care: evidence from the Family and Community Nurse model in Tuscany

BACKGROUND: The strengthening of primary care is one of the solutions proposed to increase the resilience of healthcare systems in Italy. Tuscany was the first region in Italy to use this model based on the results of a Regional Agency for Regional Health Services study. The aims is to describe the FCN model implementation across the three Local Health Authorities (LHAs) through the four C's framework of primary care. The regional resolution on FCN relabeled these milestones based on the FCN's role: transversality, proximity, continuity, customization. METHODS: A mixed method study was conducted with in-depth interviews of regional managers and surveys administered to middle nurse managers of the three LHAs. RESULTS: The interviews revealed a different state of progress of the FNC organisational model implementation, with one LHA pioneering, another LHA dealing with the implementation stage, and the third with a more recent, non-gradual implementation. The first two LHAs interpret the transversality as a strategic and the proximity as a vicinity feature. The other LHA sees the FNC as a tool for patient empowerment and proximity as service availability. The quantitative analysis shows a continuous take in charge in the pioneer LHA 54.8% (IC95% 46.8%-62.9%) with a lower temporary taking charge, 25.9% (IC95% 19.8%-31.9%), compared to the others, respectively 34.3% (IC95% 21.7%-47.0%) and 36.39% (IC95% 26.9%-45.8%). Places where the FCN provides care: the pioneering LHA as most of the home care and a 12% (IC95% 1.4%-22.5%) of intermediate care facilities use, the implementing LHA is totally home-based: 99% (IC95% 97.6%-100.3%) and with a continuous take in charge 48.6% (IC95% 34.5%-62.8), the recently implemented LHA a 6.8% (IC95% 2.2%-11.3%) of others. CONCLUSIONS: Even in the same regional context, ruled by the same features’ model defining resolution, there have been different implementations and interpretations related to the different LHAs’ organizational histories. KEY MESSAGES: • In spite of the model’s implementations, the assistance provided doesn’t focus on single diseases but on people in the broader context of their family and community. • The FCN model is designed to strengthen the timely care of patients at home by coordinating activities and care interventions through a multidisciplinary team.