According to what we learn on the basis of the news provided most recently by the press, many Sardinians risk finding themselves without a family doctor as a result of the retirements of the white coats. In essence, the specialists who had responded to the Region's call for tenders, and had therefore agreed to work in the inland countries, effectively allowing them to ensure the assistance of the public health service in the most disadvantaged locations, would find themselves currently having to bear not only the workload in the clinic, including home visits, prescriptions and processing of documents, but also the weight and commitment of the lessons and internship.

The question, if carefully considered, would seem to arise and (re)propose itself to general attention in all its problematic nature, and it would seem to require not only prompt and timely interventions, but also certain definitional profiles, aimed at definitively overcoming a phase that could probably still be defined as an emergency. Even more so when we consider the geographical characteristics of the Sardinian territory and the distribution of the population in the so-called internal areas, that is, to put it more simply, in the areas distant from the centers of concentration of essential public services, although rich in important environmental and cultural resources. And even more so when we continue to consider that precisely because they are such, such areas, as well as the population inhabiting them, would require forms of advanced management of territorial medicine organized and managed in such a way as to allow anyone who finds themselves in need of use the service in a constant and structural manner. Especially following the very serious health, economic and social crisis generated by the Covid-19 pandemic.

The specific matter, therefore, would seem to impose a series of detailed reflections concerning not only the instrumental and territorial organization of the available resources, but also their direct connection with the health needs of the territory which probably appear to have changed compared to the past also as a consequence of the pandemic period as well as of the natural aging process of the population. In the meantime, because, in such a detailed territory as the Sardinian one appears to be, it would perhaps be useful to think about stable health and welfare facilities in the internal areas that could contribute to better managing the hospital load as well. Therefore, because, even considering everything, it would seem useful not only to fully reorganize the service in the area, but also to set up essential levels of general medical care capable of guaranteeing the provision of the same levels of care throughout the entire area. Finally, because, in any case, the National Recovery and Resilience Plan seems to have foreseen the allocation of important financial resources useful for intervening on the critical issues still existing in the sector of local medicine through the creation of the so-called Community Houses, the implementation of home medical-health services, and again, the activation of community hospitals.

In this sense, and considering the specificity of the Sardinian territory, the work to be done, first and foremost in organizational terms, could appear in all its difficulty, but it would seem necessary to start preparing intervention programs that, in the immediate future, contribute to covering the needs contingent, and which in the near future can contribute to becoming a stable model of organization and development of community medicine. It would seem, moreover, that efficiency on the healthcare level also presupposes the strengthening of the connection systems of the internal areas aimed at counteracting the isolation of the Sardinian hinterland areas. As has been observed by many, the real challenge, if one wanted to define it that way, seems to be represented by the difficulty of reconciling the needs of the so-called financial sustainability of the projects with the non-negligible adequacy and clinical suitability of the services.

If, therefore, with the term "territorial medicine" we meant the set of so-called first level and emergency healthcare services which would have as their objective and purpose that of preventing the worsening of the person's pathological conditions, effectively and in fact, as a valid alternative to hospitalization, then, with good likelihood, it would be necessary to rethink the traditional model of basic medicine to make it more responsive to care needs, which, already compared to the pre-pandemic period, would seem to have changed.

It would be useful, with good likelihood, to immediately think of a sort of "Sardinia Model" aimed at the managerial and structural organization of community medicine which is suitable for involving different professionals for the best and most efficient distribution of available resources.

The objective to be pursued should be the conscious, more integrated and cohesive approach, aimed at caring for the potential patient through prevention, management of chronic diseases, palliative care, and rehabilitation. Likewise, it would be necessary to understand how digitalisation processes can be useful for this purpose in the context of the entire National Health Service which is characterized by being a system of structures and services with the aim of guaranteeing all citizens, in conditions of equality, universal access to the equitable provision of healthcare services. Intervening immediately would seem necessary just as the cooperation of all political forces, both majority and opposition, appears necessary for the best resolution of the critical issues existing in the healthcare field.

Giuseppina Di Salvatore – Lawyer, Nuoro

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