Examining South Tyrol's Experience: Digital Health Adoption and Workforce Issues in Implementing Italy's Primary Care Reform Under Ministerial Decree No. 77/2022

Abstract

Background: Ministerial Decree (D.M.) 77/2022 aims to reform Italy's primary care system by establishing community health centres and integrating digital tools to address healthcare access disparities and workforce shortages. This review focuses on frailty assessment tools, digital health innovations, and workforce challenges in the Autonomous Province of Bolzano, South Tyrol, emphasising interprofessional trust and collaboration issues. Methods: Using a narrative custom review approach guided by the SANRA checklist, this study synthesised findings from PubMed, official health websites, and regional surveys on frailty, workforce dynamics, interprofessional collaboration, and digital infrastructure in South Tyrol. Results: General practitioners (GPs) exhibited high professional motivation but expressed concerns about autonomy and administrative burdens in collaborative care models. Trust issues between GPs and specialists hinder workforce cohesion and care coordination, highlighting the need for structured inter-professional communication. Frailty assessments, such as the PRISMA-7 tool, identify over 33% of community-dwelling individuals aged 75 years and older as frail, necessitating targeted interventions. Digital health adoption, particularly electronic health records and telemedicine, is slow because of workforce shortages and infrastructure limitations. Conclusions: The successful implementation of D.M. 77/2022 in South Tyrol requires addressing workforce challenges, improving interprofessional trust, expanding digital infrastructure, and integrating frailty assessment findings into care strategies. These measures are critical for achieving a more resilient, equitable, and effective primary healthcare system.

Keywords: D.M. 77/2022; South Tyrol; digital health; electronic health records (EHRs); frailty assessment; primary care reform; telemedicine; workforce challenges.

Figure 1

Structural organisation of territorial primary healthcare services introduced by D.M. 77/2022 in Italy. The reform emphasises the decentralisation of services into community-based primary care centres, community hospitals, and home care services coordinated by the Territorial Operations Center at the district level. Patient stratification defines various levels of care needs, from low-intensity services for healthy individuals to high-intensity services for terminally ill patients, and the integration of digital tools, such as Electronic Health Records and Telemedicine. Abbreviations: COT, territorial operations center (Centrale Operativa Territoriale); CDCs, community-based primary care centers (Case della Comunità); ODC, community hospital (Ospedale di Comunità); UCP, palliative care unit (Unità di Cure Palliative); EHRs, electronic health records.

Figure 2

Framework for integrating frailty assessments, digital health tools, and workforce challenges under D.M. 77/2022 in South Tyrol. Abbreviations: AI, artificial intelligence; EHRs, electronic health records; D.M., ministerial decree (“Decreto Ministeriale”), PRISMA-7, Program on Research for Integrating Services for the Maintenance of Autonomy-7; SANRA, Scale for the Assessment of Narrative Review Articles.