Waiting lists, too many prescriptions for visits and examinations: the hunt for appropriateness begins

Waiting lists remain the number one enemy of Italians. Few, however, remember that it is not only an insufficient supply of examinations and examinations that clogs them up, but also the fact that there is a large proportion of prescriptions that are not really necessary, if not actually useless. The so-called inappropriate prescriptions, according to experts at the Ministry of Health, amount to around 20% of the specialist visits and examinations requested each year in Italy: millions of useless services prescribed by white-collar doctors who are sometimes trapped by defensive medicine - i.e. the fact that they are conditioned by patient pressure - which costs around 10 billion, resources taken away from care.

According to experts, waiting lists, like a bull with two horns, must be tackled both in terms of supply and demand: on the first front, with many difficulties, the decree on waiting lists approved by the government in the summer of 2024 has tried to do so by expanding the capacity of hospitals to focus (from weekend openings to overtime for health workers), but on the demand side, the few interventions imagined so far are contained in the health services bill that has been bogged down in the Chamber of Deputies for about a year. Now, however, something is moving: with the blessing of the Ministry of Health, the Istituto Superiore di Sanità, together with the scientific societies, has recently published a dozen Good Clinical and Care Practices - six more are on the way - on some of the most popular diagnostic examinations. These are operational tools designed to guide family doctors and specialists towards a more appropriate prescription. For example, for the complete abdomen ultrasound, one of the most requested services and "frequently affected by phenomena of prescription over-use, with relevant consequences on waiting times, on the efficiency of the system and on the equity of access to care", the recommendations focus in particular on situations in which the ultrasound scan does not bring a real clinical value: when it is used without a precise diagnostic suspicion or repeated without justification. In these cases, in addition to being useless, it can be counterproductive, encouraging the initiation of further unnecessary investigations. Among the documents already published is one on the management of carpal tunnel syndrome, one of the most common neuropathies. In this case, the recommendations make it clear that ultrasound is the preferred tool, while MRI, which is more detailed but also much more expensive, plays a 'marginal' role.

And that's not all: in order to convince doctors to use these recommendations more, a revision of the Gelli-Bianco law on clinical risk is also being studied, which aims precisely at equating good practice with guidelines as a diriment element for establishing medical liability: in practice, the white coat who follows them would only be liable in the case of gross negligence and malpractice. The measure should take concrete form through an amendment that the government is working on.

Of course, we are still talking about the first palliative measures in the face of a mountain - the mountain of inappropriate prescriptions - that still has to be climbed, and which sees the white coats on the shields, as demonstrated by the recent case of the Lazio Region, which attempted to tighten its grip on drug prescriptions, raising vehement protests from family doctors. Supporting the fact that the appropriateness of prescriptions is a central issue are also the numbers of those who book an assessment or a visit to a specialist and then do not turn up without even cancelling, thus taking away the place from those who really need it: it is estimated that the 'no-shows' are between 10 and 20 per cent of bookings. Recently, a study presented at Aress Puglia that employed artificial intelligence on over 17,000 prescriptions showed that only 39% of requests fully met the appropriateness criteria and 43% were inappropriate, while the remainder were only partially useful. In short, algorithms could also lend a hand, as the Agenas project funded by the Pnrr, which is betting on the help of AI inside doctors' offices, is trying to do.