Accorpamenti delle Aziende Sanitarie Territoriali: revisione sistematica della letteratura scientifica.

[Autom. eng. transl.] Introduction Over the past thirty years, several countries have been affected by the unification of territorial health companies in charge of primary care: the assessment of the impact and results are supported by the heads of health policies. The purpose of the systematic review is to evaluate whether there is an association between the increase in the population assisted by the Territorial Healthcare Companies and the performance after a merger. Materials and methods On the basis of the PICO model, a bibliographic research was carried out on "Medline", "Scopus" and "ISI Web of Knowledge". The selection of the articles and the extraction of the data were carried out by two co-authors separately. English-language studies were included that assessed performance by quality, process and result indicators of merged local health companies. Methodological quality was assessed through the United States 'National Institutes of Health' Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results 12/1337 articles met the inclusion criteria: nine came from England and three from Canada (Alberta). Six studies were of good quality, while the remaining six were of low quality. 103 indicators were identified: 59.2% did not change after the merger, 33.9% improved significantly and 6.9% worsened. In Canada, diabetic patients belonging to the merged territorial health companies had better glycemic control and fewer complications than those belonging to non-merged structures; in England, completed care plans and the percentage of diabetic patients undergoing an ophthalmological assessment and / or who achieved a combination of a reduction in blood pressure and blood levels of cholesterol and glycated hemoglobin increased significantly in the merged Territorial Health Units. In Canada, the merger facilitated care and therapeutic monitoring / adjustment in diabetic patients. In England, the merger created negative perceptions about managers and employees and a negative association was found between the size of the assisted population and the availability of doctors for urgent and non-urgent services. Conclusions The data on the effects of the mergers of the Territorial Healthcare Firms appear controversial, with little evidence supporting an association between the increase in the assisted population and the performance of the Territorial Healthcare Firms. Surely these combinations can lead to an improvement in the levels of care of patients with chronic diseases, such as diabetes. However, the assessments on the impact and results of the mergers of the Territorial Healthcare Companies must be related to the context and the communities in which they are carried out.