11 października NFZ skierował do konsultacji projekt zarządzenia w sprawie programu pilotażowego KOS-BAR dotyczącego kompleksowej opieki nad pacjentami z otyłością olbrzymią. Program obejmuje diagnostykę, leczenie chirurgiczne otyłości oraz rehabilitację przed- i pooperacyjną. Wdrożenie programu ma duże znaczenie dla profilaktyki i leczenia otyłości i jej powikłań, w tym również trudno gojących się ran.
Program pilotażowy KOS-BAR ma trwać 2 lata. Finansowanie programu będzie pochodziło m.in. z podatku cukrowego i wyniesie ok. 71 mln zł. Program zakłada stworzenie efektywnego modelu kompleksowej opieki nad pacjentem z otyłością olbrzymią, dostosowanego do stanu klinicznego oraz indywidualnych potrzeb osoby chorej. Wstępnie objętych programem ma zostać ok. 2 900 pacjentów.
Opublikowany 11 października projekt zarządzenia określa warunki konieczne do spełnienia przez placówkę przystępującą do pilotażu oraz stawki za realizację świadczeń. Kolejnym etapem projektu jest podpisanie umów z ośrodkami na realizację pilotażu.
Jakie są założenia programu KOS-BAR?
W ramach programu KOS-BAR przewidziane są następujące etapy leczenia::
- diagnostyka i ocena stanu zdrowia, na podstawie której pacjent zostanie zakwalifikowany do programu;
- postępowanie przedoperacyjne trwające 3-6 miesięcy przed zabiegiem;
- leczenie zabiegowe;
- rehabilitację leczniczą (przed-i pooperacyjną);
- bariatryczną opiekę specjalistyczną i monitorowanie.
Wszystkie świadczenia mają być realizowane w jednym ośrodku koordynującym. Do realizacji pilotażu wytypowano 15 ośrodków w Warszawie, Toruniu, Gdańsku, Gdyni, Białymstoku, Bydgoszczy, Łodzi, Krakowie, Lubinie, Polanicy-Zdroju, Łęcznej, Hajnówce oraz w Olsztynie.
Jak napisano w uzasadnieniu projektu, celem pracy wielospecjalistycznego zespołu, w skład którego wejdą m.in. chirurg, diabetolog, anestezjolog, fizjoterapeuta, dietetyk i psycholog, ma być przygotowanie pacjenta do leczenia chirurgicznego oraz nadzorowanie prawidłowego i niepowikłanego procesu utraty masy ciała zarówno we wczesnym, jak i odległym okresie pooperacyjnym.
Bariatryczna opieka specjalistyczna ma być realizowana przez rok od wykonania zabiegu operacyjnego. Obejmie ona regularną ocenę stanu zdrowia i odżywiania. W ramach programu przewidziano co najmniej 5 wizyt u lekarza koordynującego lub innego członka zespołu terapeutycznego.
Kto może zostać zakwalifikowany do programu KOS-BAR?
Do programu mogą zostać zakwalifikowani pacjenci powyżej 18. roku życia z rozpoznaniem ICD-10: E66.0 – otyłością spowodowaną nadmierną podażą energii, u których wskaźnik masy ciała BMI ≥ 40 kg/m², oraz pacjenci z BMI 35 – 40 kg/m², u których chirurgicznie indukowana redukcja masy ciała może przynieść potencjalną poprawę w zakresie chorób wywołanych otyłością.
Zakwalifikowany do programu pacjent otrzyma kartę KOS-BAR. Następnie złoży deklarację, pod opieką którego ośrodka koordynującego będzie chciał przebywać w trakcie trwania pilotażu.
Udziału w programie nie mogą wziąć udział pacjenci:
- z chorobami nieuleczalnymi prowadzącymi do wyniszczenia oraz chorobami stanowiącymi zagrożenie dla życia (np. choroby nowotworowe);
- z chorobami endokrynologicznymi będącymi podłożem dla otyłości;
- z ciężkimi zaburzeniami krzepnięcia krwi;
- uzależnieni od alkoholu lub narkotyków;
- chorzy psychicznie, u których choroba nie poddaje się kontroli mimo leczenia;
- z upośledzeniem umysłowym ciężkiego stopnia;
- kobiety w ciąży i karmiące piersią lub planujące ciążę w ciągu najbliższych 12 miesięcy.
Do programu nie zostaną również zakwalifikowani chorzy, którzy nie chcą się zdecydować na leczenie operacyjne.
Jaki wpływ ma leczenie bariatryczne na prewencję powikłań zdrowotnych?
Nadwaga i otyłość zwiększają ryzyko zachorowania m.in. na cukrzycę typu 2, nadciśnienie tętnicze oraz chorobę niedokrwienną serca. Schorzenia te mogą predysponować do powstawania trudno gojących się ran. Otyłość może również prowadzić do rozwoju problemów skórnych takich jak wyprzenie, rogowacenie ciemne, hiperkeratoza, łupież rumieniowy.
Chirurgiczne leczenie otyłości pozwala zmniejszyć wagę pacjenta i poprawić bilans makroelementów i pierwiastków, dzięki czemu ogranicza ryzyko wystąpienia trudno gojących się ran.
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Operacje bariatryczne – wskazania, przebieg i rola w profilaktyce ran
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