Prescriptive appropriateness and waiting times. The scientific society of gastroenterology adopt i “RAO” to review the diagnostic methods linked to pathologies: « RAOs are “groupings of homogeneous expectations” established by Agenas – explains the Dr. Sergio Segato, Director of Gastroenterology of the Asst Sette Laghi – They exist for different specialties and diagnostic tests. As a society, we are very sensitive to the issue of times but also of prescriptive correctness. We have therefore decided to give substance to those indications that the Region has already implemented in a DGR. In this way we make the diagnostic paths for the different pathologies homogeneous.”
In Italy it is calculated that 1 in 4 endoscopic examinations is not supported by valid scientific reasons. To contain demand and improve supply capacity in line with needs, they have been updated guidelines on the use of upper and lower digestive tract endoscopy: «Requests will have to be supported by specific clinical reasons – says the gastroenterologist – As for the times that must be indicated, we have defined the factors that determine the different priorities. In our sector we have no urgent requests with the U but not because there are no emergencies in gastroenterology, but simply because emergencies must be dealt with extremely quickly. So let’s talk about cases, such as hemorrhages or foreign bodies, to be treated in the emergency room. In other cases it stands out: do you have fecal occult blood and need to have a colonoscopy? Yes. Within 10 days? No, the correct time is within a month. Are you struggling to swallow and need to have a gastroscopy? Yes. Within 10 days? In this case the time indication is correct.”
The effort made at a scientific level is to define paths that have a scientific medical and non-bureaucratic administrative basis: « To achieve prescriptive correctness, we will carry out training courses with both hospital specialist colleagues and general practitioners. We have scheduled a meeting with the treating doctors after the summer to share the guidelines which are based on medical indications both in terms of investigations and the times in which these must be carried out”.
The guidelines do not constitute obligations for prescribers but indicate shared operating methods supported by scientific evidence.
The RAO model could shorten waiting lists but will not eliminate them: «It is a problem linked to supply – explains Dr. Segato – We perform between 17,000 and 18,000 endoscopic examinations every year. We can’t go beyond that because the quality would be compromised. The exam involves inserting a tube into the digestive system: it is a complex procedure, which involves careful preparation first, assistance to the patient who is sedated and then the sanctification of the environment and the instrument. The expected time is all necessary for the exam to be quality and safe.”
In a period of strong imbalance between supply and demand, one can only define priorities: « The criteria we have established aim to avoid inappropriate prescribing. You can’t give everything to everyone: doctors, with guidelines drawn up in a scientific way, will be able to be more compliant with the true need for health.”
