Riassunto
Praticare l’appropriatezza in Medicina di Laboratorio è complesso per molte ragioni: perché la definizione del concetto è andata maturando nel tempo per includere il significato di validità e di esito, ma non è ancora pienamente recepita; perché esso è contiguo ai concetti di sicurezza, efficienza ed economicità, validità del risultato, decisione clinica condivisa tra medico e paziente e infine effectiveness; perché robusti fondamenti evidence-based sui quali costruire i criteri non sono sempre presenti; perché spesso fallisce il continuo sforzo di implementazione e di verifica delle linee guida. Ma in questo campo la Medicina di Laboratorio ha un grande futuro, nella prospettiva di un sempre più proficuo lavoro all’interfaccia clinica-laboratorio in team multidisciplinari e multiprofessionali e nella consapevolezza che l’appropriatezza si declina in tutto il processo diagnostico dalla fase pre-preanalitica a quella post-postanalitica: costruire le evidenze, implementare le linee guida, gestire gli audit, offrire consulenza. Poiché il compito è corale, la funzione della Società scientifica, la sua visione della Medicina di Laboratorio e la sua Rivista sono essenziali.
Summary
Practicing appropriateness in Laboratory Medicine is a complex issue for several reasons: the concept “appropriateness” interplays with “safety”, “costs”, “decision making”, and “effectiveness”; the criteria for appropriateness are not often evidence-based and not always consensus-based; implementing guidelines and its audit are a not ending issue. Nevertheless in this field Laboratory Medicine has a great future, by multidisciplinary and multiprofessional team work at clinic-laboratory interface and awareness of appropriateness as a quality of every phase of the Total Testing Process: building evidences, implementing guidelines, collaborating to audit, offering consultation. It is a choral work for the laboratory team, and function and vision of the scientific Society and its Journal are essential.
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Bibliografia
Donabedian A (1973) Aspects of Medical Care Administration: Specifying Requirements for Health Care (Commonwelth Fund Publications). Harvard University Press, Cambridge (MA)
Cappelletti P (2004) La modernizzazione dei laboratori orientata all’appropriatezza diagnostica e all’efficacia dei trattamenti. Riv Med Lab — JLM 2:147–163
Brook RH (1994) Appropriateness: the next frontier. BMJ 308:218–219
http://www.cga.ct.gov/hs/mic/handouts/121009/Medical%20Necessity%20v.%20Medical%20Appropriateness.pdf [Accesso 20 gennaio 2013]
http://www.ahrq.gov/clinic/epc/ [Accesso 20 gennaio 2013]
http://www.nice.org.uk/ [Accesso 20 gennaio 2013]
www.salute.gov.it/imgs/C_17_pubblicazioni_28_allegato.pdf [Accesso 20 gennaio 2013]
http://www.salute.gov.it/imgs/C_17_pubblicazioni_1492_allegato.pdf [Accesso 20 gennaio 2013]
www.euro.who.int/document/e70446.pdf [Accesso 20 gennaio 2013]
Cartabellotta A (2009) Appropriatezza: istruzioni per l’uso (I). GIMBE news 1:4–5
Wilson ML (2002) Appropriate use of clinical microbiology tests. Clin Lab Med 22:491–503
Brook RH, Chassin MR, Fink A et al (1986) A method for the detailed assessment of the appropriateness of medical technologies. Int J Technol Assess Health Care 2:53–63
College of American Pathologists. Standards for laboratory accreditation (1996). Northfield (IL): College of American Pathologists (CAP)
Smellie WSA (2003) Appropriateness of test use in pathology: a new era or reinventing the wheel? Ann Clin Biochem 40:585–592
van Walraven C, Naylor CD (1998) Do we know what inappropriate Laboratory utilization is? JAMA 280:550–558
Cappelletti P (2006) Utilità diagnostica: la fase pre-preanalitica. RIMeL/IJLaM 1:5–19
Price CP (2003) Application of the principles of evidence-based medicine to laboratory medicine. Clin Chim Acta 333:147–154
Committee on quality of healthcare in America, Institute of Medicine (2001) Crossing the quality chasm: a new health system for the 21th century. National Academy Press, Washington (DC)
Bossuyt P (2011) Evidence-Based Medical Testing https://webgate.ec.europa.eu/sanco/heidi/images/a/af/2011-05_NL_CVZ_2011rpt1101-medische-tests_ENG-versie.pdf [Accesso 20 gennaio 2013]
Trikalinos TA, Siebert U, Lau J (2009) Decision-Analytic Modeling to Evaluate Benefits and Harms of Medical tests — Uses and Limitations. Agency for Healthcare Research and Quality: Rockville, MD. http://effectivehealthcare.ahrq.gov/search-forguides-reviews-and-reports/?pageaction=displayProduct&productID=347 [Accesso 20 gennaio 2013]
Witte DL (1995) Measuring outcomes: why now? Clin Chem 41:775–780
Horvath AR (2004) Quale evidenza abbiamo degli esami di laboratorio? Riv Med Lab — JLM 4:274–282
Bruns DE (2001) Laboratory-related outcomes in Healthcare. Clin Chem 47:1547–1552
Bossuyt PM, Reitsma JB, Bruns DE et al (2003) The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Clin Chem 49:7–18
Whiting P, Rutjes AW, Reitsma JB et al (2003) The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 3:3–25
Bozic KJ, Pierce RG, Herdon JH (2004) Health Care Technology Assessment. Basic principles and clinical applications. J Bone Joint Surg Am 86:1305–14.
Hvas AM, Nex E (2003) Health technology assessment: a “must” for laboratory medicine? Scand J Clin Lab Invest 63:317–318
Battista RN (2006) Expanding the scientific basis of health technology assessment: a research agenda for the next decade. Int J Technol Assess Health Care 22:275–282
Whedon JM, Davis MW, Phillips RB (2010) Implications and limitations of appropriateness studies for chiropratic. J Chiropr Humanit 17:40–46
Cappelletti P (2006) Appropriatezza in Ematologia di Laboratorio. RIMeL/IJLaM 2:119–129
www.ncbi.nlm.nih.gov/pubmed [Accesso 20 gennaio 2013]
Cabana MD, Rand CS, Powe NR et al (1999) Why don’t physicians follow Clinical Practice Guidelines? A framework for improvement. JAMA 282:1458–1465
Smellie WSA (2003) Appropriateness of test use in pathology: a new era or reinventing the wheel? Ann Clin Biochem 40:585–592
http://jcp.bmj.com/ [Accesso 20 gennaio 2013]
Cappelletti P (2011) Il futuro delle Società Scientifiche e la Società Italiana di Medicina di Laboratorio. Riv Ital Med Lab 7:127–139
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Cappelletti, P. Praticare l’appropriatezza in Medicina di Laboratorio. Un’introduzione. Riv Ital Med Lab 9, 1–7 (2013). https://doi.org/10.1007/s13631-012-0079-3
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DOI: https://doi.org/10.1007/s13631-012-0079-3