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Introduction Although Italy's NHS is funded through general taxation, the private sector plays an important role in health service provision and financing. The aim of this paper was to identify the sociodemographic and health service organizational factors associated with the propensity to seek specialist care in the private sector. Materials and methods Data were retrieved from the national Istat survey "Health conditions and use of health services" carried out in 2012-2013. We selected adults with a specialty visit in the previous 12 months in the four most frequent medical specialties: ophthalmology, cardiology, obstetrics/ gynecology and orthopedics. The study outcome was the choice to use a private service. In order to investigate the determinants of private use, we adopted the socio-behavioral model by Andersen and Newman, making a distinction between sociodemographic and healthcare organizational factors. The associations with the outcome were analyzed using chi-squared test, t-test and multivariable logistic regression analysis. Results and discussion Use of private care varied widely, from 26.3% for cardiology to 53.6% for obstetrics/gynecology. Females, patients with higher educational levels and patients with higher self-reported economic resources sought more frequently private healthcare for all specialties; younger patients and employed patients were more likely to seek private care for ophthalmic conditions. Exemption from copayment for public services reduced more than half the propensity to seek private care. Trust in this healthcare service was the main reason for private users (52.5%) followed by waiting time (26.7%) and physician choice (20.1%).

BackgroundIntermediate care (IC) services are a key component of integrated care for elderly people, providing a link between hospital and home through provision of rehabilitation and health and social care. The Patient Reported Experience Measures (PREMs) are designed to measure user experience of care in IC settings.ObjectiveTo examine the feasibility and the scaling properties of the Italian version of PREMs questionnaires for use in IC services.MethodsA cross-sectional survey was conducted on consecutive users of 1 home-based and 4 bed-based IC services in Emilia-Romagna (Italy). The main outcome measure was the PREMs questionnaire results. PREMs for each home- and bed-based IC services were translated, back-translated, and adapted through consensus among the members of the advisory board and pilot testing of face validity in 15 patients. A total of 199 questionnaires were returned from users of bed-based services and 185 were returned by mail from users of home-based services. The return rates and responses were examined. Mokken analysis was used to examine the scaling properties of the PREMs.ResultsAnalysis performed on the bed-based PREMs (N=154) revealed that 13 items measured the same construct and formed a moderate-strength scale (Loevinger H=0.488) with good reliability (Cronbach’s alpha =0.843). Analysis of home-based PREMs (N=134 records) revealed that 15 items constituted a strong scale (Loevinger H=0.543) with good reliability (Cronbach’s alpha =0.875).ConclusionThe Italian versions of the bed- and home-based IC-PREMs questionnaires proved to be valid and reliable tools to assess patients’ experience of care. Future plans include monitoring user experience over time in the same facilities and in other Italian IC settings for between-service benchmarking.

Background: Prostate-specific membrane antigen (PSMA)-ligand positron-emissiontomography (PSMA-PET) is potentially useful for screening of castration resistant prostate cancer (CRPC) clinical trial target populations. Aim: We investigated the impact of PSMA-PET on Prostate Cancer Clinical Trials Working Group 3 (PCWG3) clinical subtype classification when compared to conventional imaging (CI). Methods: Multicenter retrospective study enrolling patients with (a) PSMA-PET for CRPC, (b) PSA values ≥1 ng/mL and (c) CI, i.e. CT plus bone scan or whole-body MRI. Clinical PCWG3 subtype was determined for PET vs. CI by three blinded readers. Results: 67 patients were included and PSMA-PET led to up-staging in 15% (10/67) of patients, of these 6/10 (60%) had CI non-metastatic CRPC. PSMA-PET resulted in downstaging in 15% (10/67) of patients. Agreement for PET vs. CI PCWG3 clinical subtype was 0.81 vs. 0.51, 0.74 vs. 0.47, 0.95 vs. 0.72, or 0.59 vs. 0.66 for local, nodal, bone, or visceral disease, respectively. Conclusion: PSMA-PET demonstrated major concordance with CI for per-patient PCWG3 clinical subtype and should be implemented in future CRPC clinical trial screening procedures.