What the internist has learnt from REPOSI?
In the third millennium, internists and geriatricians must acquire a leading role, together with primary care physi- cians, in order to make health care systems fit for the management of an aging population. Are we ready for this formidable task?
The dramatic demographic changes that are occurring in the third millennium are modifying the mission of generalist professionals such as primary care physicians and internists. Multiple chronic diseases and the related prescription of multiple medications are becoming typical problems and present many challenges. Unfortu- nately, the available evidence regarding the efficacy of medications has been generated by clinical trials involving patients completely different from those currently admitted to internal medicine: much younger, affected by a single disease and managed in a highly controlled research environment. Because only registries can provide infor- mation on drug effectiveness in real-life conditions, REPOSI started in 2008 with the goal of acquiring data on elderly people acutely admitted to medical or geriatric hospital wards in Italy. The main goals of the registry were to evaluate drug prescription appropriateness, the rela- tionship between multimorbidity/polypharmacy and such cogent outcomes as hospital mortality and re-hospitaliza- tion, and the identification of disease clusters that most often concomitantly occur in the elderly. The findings of 3-yearly REPOSI runs (2008, 2010, 2012) suggest the following pertinent tasks for the internist in order to optimally handle their elderly patients: the management of multiple medications, the need to become acquainted with geriatric multidimensional tools, the promotion and implementation of a multidisciplinary team approach to patient health and care and the corresponding involvement of patients and their relatives and caregivers. There is also a need for more research, tailored to the peculiar features of the multimorbid elderly patient.
REPOSI denotes the REgistro POliterapie SIMI, Societa` Italiana di Medicina Interna. The participating units and co-authors are listed in the Appendix.
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