Meet Chiara Rafanelli, an esteemed M.D., Ph.D., Professor of Clinical Psychology and Director of the School of Specialization in Clinical Psychology at the University of Bologna. With a rich academic and professional background, she brings a wealth of knowledge and expertise to ESCAPE.

Bologna, Italy, is one of the five clinical trial locations implementing ESCAPE’s blended-collaborative care (BCC) approach, for which Chiara coordinates the implementation and supervision of the BCC intervention. The randomized controlled trial is well underway, with the team actively recruiting. While managing the complexities of the clinical trial, particularly in patient recruitment has been challenging, Chiara is very proud of the dedication her team has shown and the processes implemented to support recruitment, resulting in the pre-screening of more than 600 participants. With the progress the team has made, Chiara is optimistic about reaching the targeted number for the RCT.

The Journey to ESCAPE: Chiara’s research is primarily centred on the evaluation of the role of psychological distress and well-being in the determination of the health-disease balance, particularly in cardiac settings. Chiara emphasizes the importance of evaluating and treating from the psychological point of view both clinical and sub-clinical mental distress by employing integrated approaches, such as BCC.

Why ESCAPE? The BCC intervention actively involves patients in understanding their needs, preferences, and life goals. This model, including the care manager role, not only addresses barriers to medication adherence and promotes healthy lifestyle, but also cultivates continuous and dependable interaction with both patients and their caregivers.

“I believe that integrating the Care Manager role, supported and coordinated by a Specialist Team, into heart failure treatment will provide a more comprehensive and patient-focused strategy for managing elderly multimorbid heart failure patients within the healthcare system in Italy.”

While the utilisation of a care manager is new to the Italian healthcare system, the Cardiology Department at Bellaria Hospital had already expressed interest in similar BCC interventions, such as single in-person patient contacts. If ESCAPE’s intervention proves to be cost-effective, Chiara is optimistic about the possibility of partial integration of BCC into the local context. This would likely involve adapting existing clinical services and structures to incorporate certain aspects of the ESCAPE intervention. Priority may be given to implementing care management strategies by family and community nurses, along with adopting the ESCAPE Specialist Team meeting structure for managing heart failure patients in cardiology departments. Additionally, integrating the ESCAPE care management single contact structure for cardiac nurse assessments of heart failure patients could also be among the first steps taken.

To this, the Italian team is actively engaged in contextualizing ESCAPE’s procedures to ensure the successful implementation in the unique healthcare landscape of Bellaria Hospital. The local initiative could potentially serve as a great example for the broader adoption of BCC experience at the national level. However, it is important to recognize that transitioning from local implementation to national level integration entails significant time and effort before it can be fully realised across the entire country.

A more likely scenario will be a partial adoption of the ESCAPE BCC intervention, involving the adaptation of already present clinical services and structures to some aspects of the ESCAPE intervention. For example, the adoption of ESCAPE BCC care management strategies by family and community nurses for the management of heart failure patients.

ESCAPE’s Future: Chiara is optimistic that ESCAPE’s outcomes will highlight the benefits of the integrated care approach, particularly for elderly multimorbid heart failure patients. Looking at the bigger picture, her aspiration is for ESCAPE to enhance routine care and serving as a treatment model for diverse patient populations with complex medical conditions and associated psychosocial challenges.

Interested in learning more about Chiara’s research? Read below.

• Rafanelli, C., Gostoli, S., Buzzichelli, S., Guidi, J., Sirri, L., Gallo, P., … Rafanelli, C. (2020). Sequential Combination of Cognitive-Behavioral Treatment and Well-Being Therapy in Depressed Patients with Acute Coronary Syndromes: A Randomized Controlled Trial (TREATED-ACS Study). Psychotherapy and Psychosomatics, 89(6), 345–356. https://doi.org/10.1159/000510006
• Gostoli, S., Subach, R., Guolo, F., Buzzichelli, S., Abbate Daga, G., de Figueiredo, J. M., & Rafanelli, C. (2024). Demoralization in acute coronary syndrome: Treatment and predictive factors associated with its persistence. International journal of clinical and health psychology : IJCHP, 24(1),4 https://doi.org/10.1016/j.ijchp.2024.100444