L’appropriatezza in Medicina di Laboratorio
Laboratorio Analisi, Ospedale San Bortolo, Vicenza
Appropriateness of test request
Current pressures on the laboratory testing appropriateness are due to two main reasons: the difficulties in the sustainability of healthcare systems and the concerns about the harms of unnecessary treatments. There is growing evidence that many people are over-diagnosed and over-treated for a wide range of conditions and, consequently, a concern is growing about escalating healthcare spending; at the same time, there is an increasing effort to avoid harm when a patient is cared. However, large uncertainties remain about where and how the line between appropriate and inappropriate care should be drawn in individual cases. For laboratory tests, to distinguish between appropriate and inappropriate requests is even more difficult. In fact, the outcome deriving from performing or not a specific test depends non only on the quality of the test itself (right test, right patient, right time, right result, right decision levels, etc.), but also on the actions taken after the availability of results. An unnecessary test could be harmful for a false positive result, but even simply unhelpful or redundant. A lacking test is always dangerous, due to a possible delay in diagnosis or a misdiagnosis. Basic tests help physicians in formulating their clinical questions and represent a kind of “biochemical” patient examination. To evaluate the appropriateness of a test request, one can consider the pre-test probability of disease (avoiding to test if it is low) or we can apply an evidence-based medicine methodology to define the clinical question, searching and evaluating the available evidence, applying and finally auditing the effectiveness of the considered test.