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Preventing Unnecessary Preventive Diagnostic Tests: theory and practice

About quarternary prevention . Preventing Unnecessary Preventive Diagnostic Tests: theory and practice . Workshop at the 15 th Wonca Europe Conference Basel 2009. Donatella Sghedoni, Specialist in Public Health, Milan Giorgio Visentin, General Practitioner, Vicenza

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Preventing Unnecessary Preventive Diagnostic Tests: theory and practice

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  1. About quarternary prevention Preventing Unnecessary Preventive Diagnostic Tests: theory and practice Workshop at the 15th Wonca Europe Conference Basel 2009 • Donatella Sghedoni, Specialist in Public Health, Milan • Giorgio Visentin, General Practitioner, Vicenza • Massimo Tombesi, General Practitioner, Macerata Centre for Studies and Research in General Practice (CSeRMEG), Italy

  2. Examples of unnecessary diagnostic tests (or tests unnecessarily extended) • PSA for prostate cancer screening • Genetic screening for thrombophilia in hormonal contraception • CT scans screening for lung cancer in smokers • Yearly Pap smear, screening mammography from age 20 • Repeated screening bone densitometry • Battery of routine biochemical tests for thyroid • Imaging for uncomplicated back-pain

  3. Independent education and information for GPs: desired features • Not sponsored by manufacturers nor by specialist groups but organized by GPs and Public Health doctors • Addressing concepts such as interval cancers, overdiagnosis, practical ways of improving one’s life-style and how to communicate them to patients • With commented clinical cases and role playing or videos to allow for discussion and interaction • Proposing practical instruments (leaflets, informed consents) that may be personalized by each GP • Using also e-learning technology in case of many people to be reached

  4. Consensus conferences (desired features) • At national level • Led by GPs, involving consumers’ associations, specialists, NHS • Focused on communication with patients • Well publicized by the media • Well disseminated among GPs and Specialists • Themes already addressed in Italy : HRT, tests for thrombophylia and OC, PSA

  5. Information and communication • The Inverse Care Law "The availability of good medical care tends to vary inversely with the need for it in the population served. This ... operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced." (J.T. Hart, 1971) • becomes • “The patient more in need of health education and information is often the one more difficult to reach”

  6. What do patients believe? • To prevent is always the best option • Tests are harmless, at the most they may be superfluous • and unfortunately there are no individual experiences that may disprove these two preconceived ideas because ……..

  7. How do patients react? • If the test is done and is positive the patient usually thinks “I did the right thing” even if it is a false positive or an overdiagnosis (not recognizable in the individual) • If the test is not done and then the disease comes the natural thought is “I did the wrong thing and the doctor should have known better”

  8. What people do?

  9. DONT’s (1) when a patient (P.) asks for a preventive unnecessary test (trans. from M. Tombesi – Medicina Generale 2003)

  10. DONT’s (2) when a p. asks for a preventive unnecessary test

  11. DONT’s (3) when a p. asks for a preventive unnecessary test

  12. DONT’s (4) when a p. asks for a preventive unnecessary test

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