Abstract
In a historical period in which sustainability of the National Health Service is mandatory because of the international economical situation, the limited available resources at national level and the tendency of passing from a “population medicine” model towards the concept of “individualized medicine”, the debate on appropriateness of medical and surgical procedures is of central importance. The choosing wisely campaign, started in United States in 2012 and then spread all over the world, tries to summarize which are the most inappropriate procedures for each medical and surgical speciality; as far as allergic respiratory diseases, the most relevant Italian societies and the American Academy defined the allergological procedures with the highest probability of inappropriateness. In Italy, a recent decree of the Ministry of Health defined a list of more than 200 procedures that will be considered as inappropriate in certain conditions; many of these procedures concern allergology, including allergic respiratory diseases. In this commentary we discuss the above mentioned decree and the concept of appropriateness in the field of allergic respiratory diseases, trying to figure out some practical considerations based on the current health resources available in the field of allergology in Italy.
Highlights
Appropriateness policies have the main goal to both contain health care spending and efficiently redistribute resources
It is essential that the appropriateness is applied within the concept of evidence-based medicine (EBM) [4]
A shift in dynamics of diagnostic medicine to behaviors of appropriateness well correlates with the new cultural movements of “choosing wisely” and “slow medicine”. choosing wisely is an initiative launched by the ABIM Foundation and spread all over the world. choosing wisely aims to promote the interaction between clinicians and patients in order to support patients in choosing care that is supported by evidence, not duplicative of other tests or procedures already received, free from harm, and truly necessary [6,7,8,9]
Summary
Appropriateness policies have the main goal to both contain health care spending and efficiently redistribute resources. Into the context of the “slow medicine” international movement, it recently emerged the need to approach one important clinical problem that every physician faces in everyday clinical practice: the mis-use and over-use of medical resources (including useless exams, Fig. 1 Fundamental components and objectives to improve the appropriateness and the quality of health care surgical interventions, medical treatments, screening procedures...) which is well known to lead to increased healthcare costs (without a proportional patients’ benefit) [13] and possible harm to the patients themselves [14].
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