The justice, the glycosylated haemoglobin and the government of appropriateness

Abstract

BACKGROUND: The misappropriateness is one of the principal critical situations in the Laboratory Medicine by an estimation of about 30-40% of all demands. It results in a very high number of requested tests with possible relapses on the patient health. Obviously, the problem is also economic, therefore, undoubtedly, in the view of a principle of justice, the limited SSN economic resources must be diverted only to prescriptions useful for public welfare. AIM OF STUDY: In this work, the prescription of the glycosylated haemoglobin test is evaluated in the prospective of the "justice". This test is considered as an example of all prescriptions whose rational modalities of use have not yet been overall accepted by the scientific community. The critical situation obviously reflects on the functional use of resources, which are becoming more and more limited and therefore have to be directed only to the procedures really useful to the patient. We remark how the three principal government systems of offered laboratory services (political/administrative measures such as sanitary ticket, active rules related to scientific/health care criteria and guide lines) have demonstrated evident drawbacks whose basic indicator is represented by high rates of misappropriateness. Therefore, more diligence and involvement of physicians are required in order to propose real solutions coming from scientific premises for better diagnostic test prescriptions. It is underlined that without a direct, effective control of appropriateness, and consequently of the costs, by the clinical staff, it is inevitable that there will be somebody else who will decide and govern the demand of prescriptions in the absence of any scientific rules. CONCLUSIONS: At last, solutions are proposed for reducing the number of misappropriated requests. The opportunities coming from the information technology could permit a structural solution to the problem using a software that can automatically drive prescriptions. The aim is to give the physicians a series of "measures of prescription", produced by experts, that are then progressively spread to the majority of laboratory services. The instructions can be real time-updated and allow a widespread and well-blended knowledge all over the national territory. Prescriptions in agreement with "the instructions" would be carried out also in the hospital place. © 2008 Elsevier Srl.