THE TERRITORIAL CONTEXT
The Local Health Unit of Piacenza is organized in three territorial Districts covering the whole geographic area of the Province of Piacenza :
1. The Western District, based in Castel San Giovanni, is the smallest one (76.810 residents) and includes 21 municipalities in the western side of the province of Piacenza; its longitudinal orientation extends from the plain up to the high Apennine Trebbia and Tidone valleys.
2. The District of the City of Piacenza includes the territory of the provincial capital only (103.942 residents).
3. The Eastern District, based in Fiorenzuola d’Arda, is the most densely populated (106.400 residents) and includes 24 municipalities in the eastern side of the province. It is longitudinally oriented as well, and extends from the plain up to the high Apennine Arda and Nure Valleys.
The organization in districts is for administrative purposes only, with the aim to balance the congruence between healthcare demand (in terms of population, uniformity and territorial network) and offer/presence of healthcare facilities.
Aim of the district is to guarantee the essential level of assistance (ELA) for the population of any environment, through programming and assessement of the healthcare.
The historical trend of the total patients shows that in the first block 5 out of 20 patients come from the Western District (35% of the case), 8 from the City (40% of the cases) and 7 from the Eastern District (25% of the cases). In the second block 15 out of 52 patients come from The Western District (23% of the cases), 25 from the City (48% of the cases) and 12 from the Eastern District (29% of the cases). In the third block 10 out of 48 patients come from the Western District (20,8% of the cases), 20 from the City (41,7 % of the cases), and 15 from the Eastern District (31,25% of the cases; in this latest timeframe there are 3 non-HCU patients, i.e. not resident in the province of Piacenza (6,25% of the cases). (See table n°5 ORIGIN OF PATIENTS IN ABSOLUTE VALUE)
During the almost 15-year period of observation, 30 patients out of 120 come from the Western District (out of a population of 47.898 same age people in the current year ), 53 come from the City (out of 62.487 people) and 34 come from the Eastern District (out of 67.068 people). So, the first block represents 16,7% of the total patients, the second block 43,3% and the third block 40% of the total patients. 25% out of these 120 patients come from the Western District, 44,2% from the City and 28,3% from the Eastern District, 2,5% are non-HCU patients. The distribution of patients seems not to be related to population numerousness. The most numerous District shows a lower percentage of patients vs the urban zone where we always count the greatest number of patients.
Whilst the demographic origin of patients from the different Districts of the Local Health Unit of Piacenza (TABLES 5/6) responds to an administrative and organizational logic, the demography of patients coming from a given altitude zone (TABLES 7 ORIGIN BY ALTITUDE ZONE IN ABSOLUTE VALUE TOTALITY OF PATIENTS and 8 ORIGIN BY ALTITUDE ZONE IN PERCENTAGE TOTALITY OF PATIENTS) responds to a merely geographic logic and therefore to an organizational flow more correlated to the facilities available on the territory and, in a wider and indirect way, to ecological and cultural models. The three Altitude Zones (Mountain – Plain/Hill – City/Capital of province) are referred to the population of the municipal areas defined according to the parameters of the Italian National Institute of Statistics (ISTAT) - that are at the base of the codification system adopted by the Statistics Department of the Province of Piacenza is based  - from which the total resident Population is derived based on the sum of the five-year age classes of interest as of 01.01.2019
In coherence with the territorial number of population, the number of patients coming from Plain/Hill municipalities in absolute number seem to be the highest, while the lowest number come, of course, from the most depopulated area, the Mountain. Based on the fact that the target population in the urban area is slightly over half that of the Plain/Hill municipalities in all age ranges, the City has, in proportion, a much greater weight than the other zones in all age ranges. Moreover, the distribution-by-age of patients in charge to the ALS Team does not seem to be always consistent with the age distribution of the population in the territories of origin.
In particular, among the ALS population of the mountain, the older age group is under-represented, while the younger age group is much over-represented.
In this case, however, we must consider that absolute numbers are too low for percentages to be considered completely reliable. In the Plain/Hill and City zones the flow appears to be, at least in part, the opposite: the distribution of elderly patients seems close to the corresponding age group, while in the Plain/Hill municipalities younger age groups (both < 65 and > 75) seem to be under-represented. Among ALS patients from the city zone the middle aged group (65/75) seems to be over-represented vs the same age group of the resident population. Furthermore, the percentage point of 46,5% in the 65/75 age group is not consistent with the distribution of patients by age, whereas other age groups of patients (< 65 and > 75) seem to be consistent with the corresponding reference populations. On the totality of the followed patients in the Mountain zone, the younger ones seem to have been more frequently detected and/or sent to the ALS Team than the older ones, definitely less detected and/or sent to the ALS Team. The opposite seems to have happened in the Plain/Hill municipalities of the Province, where a greater attention seems to have been paid to older people. The age group that received the most attention in the city zone is for sure the middle-aged (65/75), with no prejudice, however, in detecting and sending to the ALS Team patients of other age groups. Generally speaking the urban area counts the greater number of patients in respect to the resident population.
comparing the number of patients coming from the different geographic/altitude zones of the Province of Piacenza as per the three segments of the cohort and based on the five-year timeframes described the research plan - block 1: 2004/2009, block 2: 2010/2014, block 3: 2015/2019 (June) –are indicative of the “historical” trend of patient detection and sending to the ALS Team. We decided not to make the comparison per cent in this table, because the absolute values per each block are too low to grant a realistic representation in percentage of the differences between the timeframes (see table n°9 ORIGIN OF PATIENTS BY ALTITUDE ZONE GROUPED BY TIMEFRAME IN ABSOLUTE VALUES). The above values show a progressive, time-related decrease of the number of patients coming from the mountain area as if they were progressively “running low”, and the older age component (> 75) still remains under-represented as previously evidenced. The figures confirm, instead, a progressively increasing attention, in the Plain/Hill zone, towards the elderly component (> 75), whose presence goes from 0 in the first block to 9 in the second block and 14 in the third block, while the trend of other age groups remains constant (< 65), except for a peak in the age range 65/75 in the second Block that returns to the previous values in the third Block. As previously noticed, the weight of the City is proportionally higher in all age groups, considering that its population is little over half that of the Plain/Hill municipalities. As well as for the Plain/Hill zone, also in the urban area the numerousness of elder patient component (> 75) increases progressively over time, even though the number of patients belonging to the other age ranges remains quite stable. Just like the Plain/Hill zone, also the urban area registers a peak of patients ageing 65/75 in the second block (2010 ÷ 2014) that returns to the previous values in the third block.
Summarizing the data relating to the altitude zone in the above tables, we can therefore assume an ever increasing detection and/or sending of patients to the ALS team from the urban territory, with an increase in the older age component, particularly evident in the Plain/Hill municipalities as well. On the contrary, the access to the service – like other facilities - seems to become more difficult for patients from the Mountain, also due to progressive depopulation.