{"id":16640,"date":"2024-04-29T09:37:12","date_gmt":"2024-04-29T09:37:12","guid":{"rendered":"https:\/\/leicesterleicestershireandrutland.icb.nhs.uk\/?p=16640"},"modified":"2024-12-11T13:49:41","modified_gmt":"2024-12-11T13:49:41","slug":"policy-for-leicester-leicestershire-and-rutland-approved-referral-pathways","status":"publish","type":"post","link":"https:\/\/leicesterleicestershireandrutland.icb.nhs.uk\/ro\/policy-for-leicester-leicestershire-and-rutland-approved-referral-pathways\/","title":{"rendered":"Politica pentru c\u0103ile de trimitere aprobate pentru Leicester, Leicestershire \u0219i Rutland"},"content":{"rendered":"

1. INTRODUCERE<\/strong><\/p>\n\n\n\n

Aceast\u0103 politic\u0103 descrie pragul clinic \u0219i criteriile de excludere pe care Consiliul de \u00eengrijire integrat\u0103 (ICB) din Leicester, Leicestershire \u0219i Rutland (LLR) a fost de acord pentru procedurile \u0219i tratamentele planificate cuprinse \u00een aceast\u0103 politic\u0103. De la ratificarea ini\u021bial\u0103 \u00een 2018, politicile au fost revizuite.<\/p>\n\n\n\n

V\u0103 rug\u0103m s\u0103 re\u021bine\u021bi c\u0103 toate preocup\u0103rile cu semnalul ro\u0219u \u0219i 2 c\u0103i WW sunt exclus<\/strong> din acest document.<\/p>\n\n\n\n

    <\/ol>\n\n\n\n

    Politicile erau cunoscute anterior drept C\u0103i de recomandare aprobate, pentru a evita interpretarea gre\u0219it\u0103, LLR ICB au primit feedback \u0219i le-au redenumit pe fiecare drept Politici LLR.<\/p>\n\n\n\n

    Toate politicile examinate sunt disponibile @  <\/strong>https:\/\/leicesterleicestershireandrutland.icb.nhs.uk\/your-health\/healthcare-and-treatment-policies\/<\/a><\/p>\n\n\n\n

    1.1 CONTEXT<\/strong><\/p>\n\n\n\n

    Acest document de politic\u0103 a fost acceptat \u0219i este sus\u021binut de NHS Leicester, Leicestershire \u0219i Rutland ICB<\/p>\n\n\n\n

      \n
    1. <\/li>\n<\/ol>\n\n\n\n

      Politicile urm\u0103resc s\u0103 \u00eembun\u0103t\u0103\u021beasc\u0103 consecven\u021ba accesului, astfel \u00eenc\u00e2t s\u0103 permit\u0103 un tratament planificat corect \u0219i echitabil pentru popula\u021bia din LLR. Acesta asigur\u0103 c\u0103:<\/p>\n\n\n\n

        \n
      • Pacien\u021bii primesc tratamente adecvate de s\u0103n\u0103tate la locul potrivit \u0219i la momentul potrivit.<\/li>\n\n\n\n
      • Tratamentele f\u0103r\u0103 o baz\u0103 de dovezi clinice sau cu o baz\u0103 foarte limitat\u0103 nu sunt utilizate.<\/li>\n<\/ul>\n\n\n\n

        Consiliile de \u00eengrijire integrat\u0103 (ICB) sunt responsabile pentru punerea \u00een func\u021biune a serviciilor de asisten\u021b\u0103 medical\u0103 care \u00eendeplinesc cerin\u021bele rezonabile ale popula\u021biei lor. Acest lucru se face \u00een cadrul unui pachet financiar convenit. Aceast\u0103 politic\u0103 permite ICB s\u0103-\u0219i prioritizeze resursele folosind cele mai bune dovezi despre ceea ce este eficient din punct de vedere clinic \u0219i s\u0103 ofere cel mai mare c\u00e2\u0219tig de s\u0103n\u0103tate demonstrat.<\/p>\n\n\n\n

        1.2 PRINCIPII<\/strong><\/p>\n\n\n\n

        Acestea au fost realizate \u00een consultare cu medicii de \u00eengrijire primar\u0103 \u0219i secundar\u0103, cu reprezentan\u021bii din domeniul s\u0103n\u0103t\u0103\u021bii publice \u0219i al pacien\u021bilor \u0219i au fost revizuite \u00een conformitate cu principiile enun\u021bate mai jos, al\u0103turi de politicile na\u021bionale de interven\u021bie bazat\u0103 pe dovezi:<\/p>\n\n\n\n

          \n
        • Dovezi clare ale eficacit\u0103\u021bii clinice.<\/li>\n\n\n\n
        • Dovezi clare ale eficien\u021bei costurilor.<\/li>\n\n\n\n
        • Costul tratamentului pentru pacient a fost luat \u00een considerare.<\/li>\n\n\n\n
        • M\u0103sura \u00een care indivizii sau grupurile de pacien\u021bi vor beneficia de tratament<\/li>\n\n\n\n
        • Echilibra\u021bi nevoile individului cu beneficiile care ar putea fi ob\u021binute prin posibilit\u0103\u021bi alternative de investi\u021bii pentru a satisface nevoile comunit\u0103\u021bii.<\/li>\n\n\n\n
        • Lua\u021bi \u00een considerare toate standardele na\u021bionale relevante ca un ghid autorizat.<\/li>\n\n\n\n
        • Acolo unde tratamentul este sus\u021binut, acesta este livrat \u00een cel mai potrivit cadru clinic, \u00een func\u021bie de nevoia clinic\u0103.<\/li>\n<\/ul>\n\n\n\n

          Aceast\u0103 politic\u0103 rezum\u0103 procedurile \u0219i tratamentele planificate pe care LLR ICB fie nu le va finan\u021ba, fie le va finan\u021ba atunci c\u00e2nd pacientul atinge un prag clinic specificat. Aceste praguri au fost convenite \u00een consultare cu clinicienii de la Spitalele Universitare Leicester (UHL) \u0219i fostii conduc\u0103tori clinici CCG \u0219i actuali ICB.<\/p>\n\n\n\n

          Politicile sunt clasificate astfel:<\/p>\n\n\n\n

            \n
          • Nu este finan\u021bat \u00een mod obi\u0219nuit.<\/li>\n\n\n\n
          • Criterii de prag.<\/li>\n<\/ul>\n\n\n\n

            1.3<\/strong>      TRATAMENTUL SAU PROCEDURA NU FINAN\u021aATE DE RUTIN\u0102<\/strong><\/p>\n\n\n\n

            Acesta este un grup de tratamente sau proceduri pe care LLR ICB nu le finan\u021beaz\u0103, deoarece lipsa tratamentului sau procedurii nu va avea un impact negativ asupra bun\u0103st\u0103rii fizice sau psihice a pacientului.<\/p>\n\n\n\n

            Cu toate acestea, LLR ICB voi<\/strong> finan\u021beaz\u0103 aceste tratamente\/proceduri \u00een urm\u0103toarele circumstan\u021be:<\/p>\n\n\n\n

              \n
            • Traum\u0103 post-fizic\u0103.<\/li>\n\n\n\n
            • Parte dintr-o reconstruc\u021bie dup\u0103 o interven\u021bie chirurgical\u0103, de exemplu, pentru cancer.<\/li>\n\n\n\n
            • Parte a gestion\u0103rii unei anomalii congenitale care are ca rezultat un deficit grav al func\u021biei de s\u0103n\u0103tate.<\/li>\n\n\n\n
            • Pentru o afec\u021biune direct atribuit\u0103 unui tratament medical anterior furnizat \u00een cadrul NHS. Aceasta exclude efectele secundare cunoscute ale unui tratament sau posibilele complica\u021bii despre care pacientul ar fi \u00een mod normal notificat ca parte a beneficiilor \u0219i riscurilor proceselor de consim\u021b\u0103m\u00e2nt.<\/li>\n\n\n\n
            •  Tratamentul va fi finan\u021bat dac\u0103 an Cerere de finan\u021bare individual\u0103<\/strong> (IFR) demonstreaz\u0103 c\u0103 exist\u0103 o nevoie clinic\u0103 excep\u021bional\u0103, care este sus\u021binut\u0103 \u0219i de ICB.<\/li>\n<\/ul>\n\n\n\n

              1.4<\/strong>      CRITERII DE PRAG PENTRU TRATAMENT SAU PROCEDURA<\/strong><\/p>\n\n\n\n

              Aceasta \u00eenseamn\u0103 c\u0103 LLR ICB va finan\u021ba tratamentul sau procedura numai dac\u0103 pacientul \u00eendepline\u0219te pragul clinic stabilit pentru tratament.<\/p>\n\n\n\n

              1.5 CERERE INDIVIDUAL\u0102 DE FINAN\u021aARE (IFR)<\/strong><\/p>\n\n\n\n

              Pot exista momente \u00een care este adecvat din punct de vedere clinic s\u0103 se finan\u021beze o procedur\u0103 care este NU ESTE FINAN\u021aAT DE RUTIN\u0102<\/strong>. LLR ICB va lua \u00een considerare aceste solicit\u0103ri de la caz la caz, prin aplicarea c\u0103tre panelul IFR. V\u0103 rug\u0103m s\u0103 consulta\u021bi Calea PRISM DE CERERE INDIVIDUAL\u0102 DE FINAN\u021aARE (IFR). <\/strong>pentru formulare \u0219i \u00eendrum\u0103ri.<\/p>\n\n\n\n

              Panelul se va concentra pe urm\u0103toarele:<\/p>\n\n\n\n

                \n
              • Exist\u0103 tr\u0103s\u0103turi clinice ale cazului pacientului care \u00eel fac pe pacient semnificativ diferit de popula\u021bia general\u0103 de pacien\u021bi cu afec\u021biunea \u00een cauz\u0103 \u00een acela\u0219i stadiu de progresie a afec\u021biunii?<\/li>\n\n\n\n
              • Este probabil ca pacientul s\u0103 ob\u021bin\u0103 beneficii semnificativ mai mari de pe urma interven\u021biei solicitate dec\u00e2t s-ar putea a\u0219tepta \u00een mod normal pentru popula\u021bia general\u0103 de pacien\u021bi cu afec\u021biune \u00een acela\u0219i stadiu al progresiei afec\u021biunii?<\/li>\n<\/ul>\n\n\n\n

                1.6 APROBARE PREALABIL\u0102<\/strong><\/p>\n\n\n\n

                APROBAREA PREALABIL\u0102 este un alt punct de verificare pentru a se asigura c\u0103 pacientul \u00eendepline\u0219te criteriile de prag.<\/strong><\/p>\n\n\n\n

                Acest proces este gestionat de o ter\u021b\u0103 parte, care poate solicita informa\u021bii suplimentare \u0219i poate compara recomandarea cu criteriile politicii.<\/p>\n\n\n\n

                Procesul de sesizare poate fi g\u0103sit pe web PRISM, toate informa\u021biile necesare trebuie s\u0103 \u00eenso\u021beasc\u0103 trimiterea \u0219i trimise la lcr.ifr@nhs.net<\/p>\n\n\n\n

                Un grup format dintr-o consulta\u021bie de s\u0103n\u0103tate public\u0103, un medic generalist \u0219i un consultant \u00een chirurgie plastic\u0103 se \u00eent\u00e2lnesc bilunar pentru a revizui recomand\u0103rile cu dovezi justificative. Medicul de familie \u0219i pacientul vor fi notifica\u021bi \u00een scris cu privire la rezultatul cererii de finan\u021bare.<\/p>\n\n\n\n

                Furnizorii trebuie s\u0103 se asigure c\u0103 a fost acordat\u0103 APROBAREA PREALABIL\u0102 \u00eenainte de a \u00eencepe orice cale de tratament.<\/p>\n\n\n\n

                 1.7 EVALUAREA IMPACTULUI DE EGALITATE \u0218I CALITATE<\/strong><\/p>\n\n\n\n

                 LLR ICB a evaluat impactul politicilor asupra popula\u021biei din LLR \u00een cazul \u00een care acestea au fost modific\u0103ri majore ale politicilor<\/p>\n\n\n\n

                1.8 MONITORIZARE \u0218I REVIZUIRE<\/strong><\/p>\n\n\n\n

                Aceast\u0103 politic\u0103 va fi supus\u0103 monitoriz\u0103rii continue folosind o combina\u021bie de urm\u0103toarele abord\u0103ri:<\/p>\n\n\n\n

                  \n
                • Proces de aprobare prealabil\u0103.<\/li>\n\n\n\n
                • Cereri individuale de finan\u021bare.<\/li>\n\n\n\n
                • Monitorizarea post-activitate prin datele de rutin\u0103 privind activitatea EBI.<\/li>\n\n\n\n
                • Monitorizare post activitate prin audituri clinice ad-hoc.<\/li>\n<\/ul>\n\n\n\n

                  2.0 NU ESTE FINAN\u021aAT DE RUTIN\u0102<\/strong> <\/p>\n\n\n\n

                  Urm\u0103torul tabel listeaz\u0103 toate c\u0103ile de trimitere aprobate de LLR care NU sunt finan\u021bate \u00een mod obi\u0219nuit.<\/p>\n\n\n\n

                  1.<\/strong><\/td>Toxina botulinica pentru riduri<\/td><\/tr>
                  2.<\/strong><\/td>Ridicarea s\u00e2nilor (Mastopexie)<\/td><\/tr>
                  3.<\/strong><\/td>M\u0103rirea gambei<\/td><\/tr>
                  4.<\/strong><\/td>Implant de obraz\/barbie<\/td><\/tr>
                  5.<\/strong><\/td>Colecistectomie - asimptomatic\u0103<\/td><\/tr>
                  6.<\/strong><\/td>Implant de colagen<\/td><\/tr>
                  7.<\/strong><\/td>Terapii gratuite<\/td><\/tr>
                  8.<\/strong><\/td>Corectarea invers\u0103rii mamelonului<\/td><\/tr>
                  9.<\/strong><\/td>Resurfacing cu laser dermoabraziune<\/td><\/tr>
                  10.<\/strong><\/td>Repararea lobilor urechii<\/td><\/tr>
                  11.<\/strong><\/td>Simpatectomie toracic\u0103 endoscopic\u0103<\/td><\/tr>
                  12.<\/strong><\/td>Excizia pielii pentru indica\u021bii cosmetice<\/td><\/tr>
                  13.<\/strong><\/td>Lifting facial<\/td><\/tr>
                  14.<\/strong><\/td>Grefe de gr\u0103sime<\/td><\/tr>
                  15.<\/strong><\/td>Schimbarea de gen<\/td><\/tr>
                  16.<\/strong><\/td>M\u0103rirea feselor<\/td><\/tr>
                  17.<\/strong><\/td>Depilarea p\u0103rului pentru o cre\u0219tere excesiv\u0103<\/td><\/tr>
                  18.<\/strong><\/td>Transplant de p\u0103r<\/td><\/tr>
                  19.<\/strong><\/td>Labioplastie, vaginoplastie \u0219i reconstruc\u021bie himen<\/td><\/tr>
                  20.<\/strong><\/td>Tratament cu laser pentru miopie<\/td><\/tr>
                  21.<\/strong><\/td>Liposuctie<\/td><\/tr>
                  22.<\/strong><\/td>Ecografia focalizat\u0103 ghidat\u0103 prin rezonan\u021b\u0103 magnetic\u0103 pentru fibroamele uterine<\/td><\/tr>
                  23.<\/strong><\/td>Faloplastia<\/td><\/tr>
                  24.<\/strong><\/td>Fotodistrugerea pielii<\/td><\/tr>
                  25.<\/strong><\/td>Inversarea steriliz\u0103rii<\/td><\/tr>
                  26.<\/strong><\/td>Lifting pentru fese \u0219i bra\u021be<\/td><\/tr>
                  27.<\/strong><\/td>Ultrasunete pentru vindecarea osoas\u0103 cu intensitate sc\u0103zut\u0103<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

                  3 CRITERII DE PRAG<\/strong><\/p>\n\n\n\n

                  Urm\u0103torul tabel listeaz\u0103 toate c\u0103ile de trimitere aprobate de LLR care au criterii de prag clinic.<\/p>\n\n\n\n

                  1.<\/strong><\/td>Hernie abdominal\u0103<\/td><\/tr>
                  2.<\/strong><\/td>Abdominoplastie<\/td><\/tr>
                  3.<\/strong><\/td>Keratoza actinic\u0103<\/td><\/tr>
                  4.<\/strong><\/td>Alopecia<\/td><\/tr>
                  5.<\/strong><\/td>Artroscopia genunchiului<\/td><\/tr>
                  6.<\/strong><\/td>Leziuni benigne ale pielii<\/td><\/tr>
                  7.<\/strong><\/td>Asimetria sanilor<\/td><\/tr>
                  8.<\/strong><\/td>\u00cendep\u0103rtarea \u0219i reinser\u021bia implantului mamar<\/td><\/tr>
                  9.<\/strong><\/td>Reducerea s\u00e2nilor<\/td><\/tr>
                  10.<\/strong><\/td>Ridicarea spr\u00e2ncenelor<\/td><\/tr>
                  11.<\/strong><\/td>Bunions<\/td><\/tr>
                  12.<\/strong><\/td>Tunelul carpian<\/td><\/tr>
                  13.<\/strong><\/td>Cataracte<\/td><\/tr>
                  14.<\/strong><\/td>Chalazion<\/td><\/tr>
                  15.<\/strong><\/td>Circumcizia \u2013 Mascul Adult<\/td><\/tr>
                  16.<\/strong><\/td>Leziune pigmentat\u0103 congenital\u0103 a fe\u021bei<\/td><\/tr>
                  17.<\/strong><\/td>Crioconservare \u2013 Gamet\/Embrion<\/td><\/tr>
                  18.<\/strong><\/td>Boala Dupuytren<\/td><\/tr>
                  19.<\/strong><\/td>\u00cendep\u0103rtarea cear\u0103 a urechilor<\/td><\/tr>
                  20.<\/strong><\/td>Repararea anevrismului endovascular<\/td><\/tr>
                  21.<\/strong><\/td>Endoscopie pentru dispepsie<\/td><\/tr>
                  22.<\/strong><\/td>Chist Pilar Epidermoid<\/td><\/tr>
                  23.<\/strong><\/td>Injec\u021bii epidurale pentru durerea radicular\u0103<\/td><\/tr>
                  24.<\/strong><\/td>Disfunc\u021bia erectil\u0103<\/td><\/tr>
                  25.<\/strong><\/td>Injec\u021bie articular\u0103 cu fa\u021bete pentru durerea non-radicular\u0103<\/td><\/tr>
                  26.<\/strong><\/td>Hiperpigmentarea facial\u0103 a fe\u021bei<\/td><\/tr>
                  27.<\/strong><\/td>Infec\u021bie fungic\u0103 a unghiilor<\/td><\/tr>
                  28.<\/strong><\/td>Ganglion<\/td><\/tr>
                  29.<\/strong><\/td>Fundoplica\u021bia gastric\u0103 pentru esofagita de reflux cronic\u0103<\/td><\/tr>
                  30.<\/strong><\/td>Inser\u021bii de grommet \u2013 adul\u021bi<\/td><\/tr>
                  31.<\/strong><\/td>\u00cenlocuire de \u0219old \u0219i genunchi<\/td><\/tr>
                  32.<\/strong><\/td>Artroscopie de \u0219old<\/td><\/tr>
                  33.<\/strong><\/td>Resurfacing \u0219old<\/td><\/tr>
                  34.<\/strong><\/td>Revizuire hibrid\u0103 de \u00eenlocuire a genunchiului<\/td><\/tr>
                  35.<\/strong><\/td>Implant de lentile intraoculare<\/td><\/tr>
                  36.<\/strong><\/td>Inseminarea intrauterina si inseminarea cu donator<\/td><\/tr>
                  37.<\/strong><\/td>Refacerea genunchiului<\/td><\/tr>
                  38.<\/strong><\/td>Tratament cu laser<\/td><\/tr>
                  39.<\/strong><\/td>Lipoma<\/td><\/tr>
                  40.<\/strong><\/td>Dureri de spate \u2013 Interven\u021bie chirurgical\u0103<\/td><\/tr>
                  41.<\/strong><\/td>Simptome ale tractului urinar inferior<\/td><\/tr>
                  42.<\/strong><\/td>Reducerea sanilor masculini<\/td><\/tr>
                  43.<\/strong><\/td>Osteotomie maxilar\u0103 mandibular\u0103<\/td><\/tr>
                  44.<\/strong><\/td>Bloc de ramur\u0103 medial\u0103 \u0219i injec\u021bie articular\u0103 fa\u021bet\u0103<\/td><\/tr>
                  45.<\/strong><\/td>Miringotomie cu sau f\u0103r\u0103 oeje \u2013 numai pentru copii<\/td><\/tr>
                  46.<\/strong><\/td>Tratament nazal non-cosmetic \u2013 Toate v\u00e2rstele<\/td><\/tr>
                  47<\/strong><\/td>Urechi proeminente<\/td><\/tr>
                  48.<\/strong><\/td>Denervarea cu radiofrecven\u021b\u0103 \u00een gestionarea durerii cronice de spate<\/td><\/tr>
                  49.<\/strong><\/td>Sindromul picioarelor nelinistite<\/td><\/tr>
                  50<\/strong><\/td>Rinofima<\/td><\/tr>
                  51.<\/strong><\/td>Reducerea cicatricilor<\/td><\/tr>
                  52.<\/strong><\/td>Umflarea scrotului asimptomatic\u0103<\/td><\/tr>
                  53.<\/strong><\/td>A doua \u0219i a treia p\u0103rere de specialitate<\/td><\/tr>
                  54.<\/strong><\/td>Referire pentru apneea \u00een somn<\/td><\/tr>
                  55.<\/strong><\/td>Sterilizare - feminin \u0219i masculin<\/td><\/tr>
                  56.<\/strong><\/td>Plas\u0103 biologic\u0103 chirurgical\u0103 \u2013 utilizarea<\/td><\/tr>
                  57.<\/strong><\/td>Amigdalectomie \u0219i adenoidectomie<\/td><\/tr>
                  58.<\/strong><\/td>Disfunc\u021bia articula\u021biei temporomandibulare<\/td><\/tr>
                  59.<\/strong><\/td>Leg\u0103turi pentru limb\u0103<\/td><\/tr>
                  60.<\/strong><\/td>Presiune negativ\u0103 topic\u0103<\/td><\/tr>
                  61.<\/strong><\/td>Degetul de declan\u0219are<\/td><\/tr>
                  62.<\/strong><\/td>Prolaps uterovaginal<\/td><\/tr>
                  63.<\/strong><\/td>Pesare vaginale<\/td><\/tr>
                  64.<\/strong><\/td>Varice<\/td><\/tr>
                  65.<\/strong><\/td>Vitiligo<\/td><\/tr>
                  66.<\/strong><\/td>Chirurgie cutie vocal\u0103<\/td><\/tr>
                  67.<\/strong><\/td>Decompresie artroscopic\u0103 a um\u0103rului pentru durerea subacromial\u0103<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

                  <\/p>\n\n\n\n

                  Data revizuirii ARP 1: 2027<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n


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