Lorenzoni Roberto, Baldini Paolo, Bernardi Daniele, Bonatti Vincenzo, Dabizzi Roberto, Del Citerna Federico, De Tommasi Mario, Galli Michele, Giannini Raffaella, Macrì Rocco, Mandorla Sara, Mazzoni Vincenzo, Micheli Giovanni, Nannini Eugenio, Pesola Antonio, Severi Silva, Tartarini Giuseppe, Tonelli Luigi, Vergoni William, Vergassola Rossano, Zuppiroli Alfredo
U.O. di Malattie Cardiovascolari Ospedale Campo di Marte 55100 Lucca.
Ital Heart J Suppl. 2002 Jun;3(6):607-12.
We evaluated the appropriateness of the prescription of echocardiography, exercise testing, Holter monitoring and vascular sonography for ambulatory patients, performed during 4 weeks in 21 outpatient laboratories in Tuscany and Umbria, Italy.
We collected the following data: the appropriateness of the prescription (according to the guidelines of the Italian Federation of Cardiology), the prescribing physician (cardiologist vs noncardiologist), the synthetic result (normal vs abnormal) and the clinical utility (useful vs useless) of each exam.
We evaluated 5614 prescriptions (patients: 3027 males, 2587 females; mean age 63 years, range 14-96 years). The indication to the test was of class I (appropriate) in 45.3%, of class II (doubtfully appropriate) in 34.8% and of class III (inappropriate) in 19.9% of the cases. The test was abnormal in 58.3% of class I exams vs 17% of class III exams (p < 0.05). The test was useful in 72.4% of class I exams vs 17.1% of class III exams (p < 0.05). The test was prescribed by a cardiologist in 1882 cases (33.5%). Cardiologist-prescribed exams were of class I in 57.3%, of class II in 32.4% and of class III in 10.3% of the cases vs 39.2, 36.1 and 24.7% of non-cardiologist-prescribed exams (p < 0.05). Cardiologist-prescribed exams were abnormal in 53.4% of the cases vs 39% of those of non-cardiologists' (odds ratio 1.76, 95% confidence interval 1.58-1.97; p < 0.05). Cardiologist-prescribed exams were useful in 64.7% of the cases vs 44.4% of those of non-cardiologists' (odds ratio 2.26, 95% confidence interval 2.02-2.53; p < 0.05).
In Tuscany and Umbria, Italy, less than half of the prescriptions for non-invasive diagnostic tests are appropriate: appropriately prescribed exams more often provide abnormal and useful results; cardiologist-prescribed exams are more often appropriate, abnormal and useful.
我们评估了意大利托斯卡纳和翁布里亚地区21家门诊实验室在4周内为门诊患者开具超声心动图、运动试验、动态心电图监测和血管超声检查处方的合理性。
我们收集了以下数据：处方的合理性（根据意大利心脏病学会联合会的指南）、开处方的医生（心脏病专家与非心脏病专家）、每项检查的综合结果（正常与异常）以及临床实用性（有用与无用）。
我们评估了5614份处方（患者：男性3027例，女性2587例；平均年龄63岁，范围14 - 96岁）。检查指征为I类（合适）的病例占45.3%，II类（可疑合适）的占34.8%，III类（不合适）的占19.9%。I类检查中58.3%结果异常，而III类检查中这一比例为17%（p < 0.05）。I类检查中72.4%结果有用，而III类检查中为17.1%（p < 0.05）。1882例（33.5%）检查由心脏病专家开具。心脏病专家开具的检查中，I类占57.3%，II类占32.4%，III类占10.3%；而非心脏病专家开具的检查中这一比例分别为39.2%、36.1%和24.7%（p < 0.05）。心脏病专家开具的检查中53.4%结果异常，而非心脏病专家开具的检查中这一比例为39%（优势比1.76，95%置信区间1.58 - 1.97；p < 0.05）。心脏病专家开具的检查中64.7%结果有用，而非心脏病专家开具的检查中为44.4%（优势比2.26，95%置信区间2.02 - 2.53；p < 0.05）。
在意大利托斯卡纳和翁布里亚地区，不到一半的非侵入性诊断检查处方是合适的：开具合理的检查更常得出异常且有用的结果；心脏病专家开具的检查更常是合适、异常且有用的。
