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Appropriateness in allergic respiratory diseases health care in Italy: definitions and organizational aspects.

Lombardi C, Savi E, Costantino MT, Heffler E, Milanese M, Passalacqua G, Canonica GW, Italian Allergic Respiratory Diseases Task For - Clin Mol Allergy (2016)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Departmental Unit of Allergology-Clinical Immunology and Respiratory Diseases, Fondazione Poliambulanza of Brescia, Via Bissolati, 57, Brescia, Italy.

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.

No MeSH data available.


Related in: MedlinePlus

Fundamental components and objectives to improve the appropriateness and the quality of health care
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Fig1: Fundamental components and objectives to improve the appropriateness and the quality of health care

Mentions: Choosing wisely recommendations meant to identify which are appropriate and necessary procedures or treatments. As each patient situation is unique, providers and patients should use the recommendations as guidelines to determine an appropriate treatment plan together. In other words, a diagnostic or therapeutic procedure can be considered appropriate when it is delivered according to clinical indications with proven efficacy, at the right time, in accordance with appropriate mode. In Italy, the appropriateness of healthcare is increasingly gaining the interest health care providers and policy-makers. In fact, in Italy, a major topic of the current health care debate is that a substantial proportion of the health care delivered is inappropriate. Recently, the Italian Ministry of Health has presented a decree, known as “Appropriateness Decree”. This decree has been published in the “Gazzetta Ufficiale” of January 20, 2016, and it contains a list of more than 203 diagnostic tests with the criteria of appropriateness and prescriptive constraints. The “Gazzetta Ufficiale” is a document containing the laws passed by the government.This action arised a widespread mediatic debate, as the unusual pairing of the prescription appropriateness (“cultural and professional”) and penalty mechanisms (“contractual interest and trade union”) have been considered to be insufficiently shared with medical doctors. Since respiratory allergies (oculorhinitis and bronchial asthma) have an important epidemiological and social health impact, it becomes important to establish a “virtuous” diagnostic flow chart that must be in line with the innovative concepts of appropriateness, and the new findings on diagnostic procedures. Within the physicians (allergists, pulmonologists, pediatricians, general practitioners, etc.) that interface with patients suffering from respiratory allergies, it also becomes important to establish “who does what” and make the harmonious interplay between the various health care providers. Purpose of this article is to make a contribution to improve these dynamics. The fundamental objective in approaching allergic respiratory diseases is that each patient receives the procedures with the best possible outcome and satisfaction based on knowledge available, the least risk of damage following treatment and the lowest consumption of resources (Fig. 1).Fig. 1


Appropriateness in allergic respiratory diseases health care in Italy: definitions and organizational aspects.

Lombardi C, Savi E, Costantino MT, Heffler E, Milanese M, Passalacqua G, Canonica GW, Italian Allergic Respiratory Diseases Task For - Clin Mol Allergy (2016)

Fundamental components and objectives to improve the appropriateness and the quality of health care
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4837511&req=5

Fig1: Fundamental components and objectives to improve the appropriateness and the quality of health care
Mentions: Choosing wisely recommendations meant to identify which are appropriate and necessary procedures or treatments. As each patient situation is unique, providers and patients should use the recommendations as guidelines to determine an appropriate treatment plan together. In other words, a diagnostic or therapeutic procedure can be considered appropriate when it is delivered according to clinical indications with proven efficacy, at the right time, in accordance with appropriate mode. In Italy, the appropriateness of healthcare is increasingly gaining the interest health care providers and policy-makers. In fact, in Italy, a major topic of the current health care debate is that a substantial proportion of the health care delivered is inappropriate. Recently, the Italian Ministry of Health has presented a decree, known as “Appropriateness Decree”. This decree has been published in the “Gazzetta Ufficiale” of January 20, 2016, and it contains a list of more than 203 diagnostic tests with the criteria of appropriateness and prescriptive constraints. The “Gazzetta Ufficiale” is a document containing the laws passed by the government.This action arised a widespread mediatic debate, as the unusual pairing of the prescription appropriateness (“cultural and professional”) and penalty mechanisms (“contractual interest and trade union”) have been considered to be insufficiently shared with medical doctors. Since respiratory allergies (oculorhinitis and bronchial asthma) have an important epidemiological and social health impact, it becomes important to establish a “virtuous” diagnostic flow chart that must be in line with the innovative concepts of appropriateness, and the new findings on diagnostic procedures. Within the physicians (allergists, pulmonologists, pediatricians, general practitioners, etc.) that interface with patients suffering from respiratory allergies, it also becomes important to establish “who does what” and make the harmonious interplay between the various health care providers. Purpose of this article is to make a contribution to improve these dynamics. The fundamental objective in approaching allergic respiratory diseases is that each patient receives the procedures with the best possible outcome and satisfaction based on knowledge available, the least risk of damage following treatment and the lowest consumption of resources (Fig. 1).Fig. 1

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Departmental Unit of Allergology-Clinical Immunology and Respiratory Diseases, Fondazione Poliambulanza of Brescia, Via Bissolati, 57, Brescia, Italy.

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.

No MeSH data available.


Related in: MedlinePlus