Condivisione anziché delibere: dalla formazione sul campo alla valutazione del cambiamento

È stato progettato e condotto nel 2012 un intervento formativo in presenza e sul campo, indirizzato all’appropriatezza prescrittiva di PSA, VES, PCR e degli esami prima di terapia estro-progestinica. Tutti i 430 medici di medicina generale (MMG) della ASL TO3, suddivisi in 28 equipe locali di circa 20 medici l’una, hanno partecipato a 2 incontri in plenaria, intercalati da lavoro personale e di equipe sui propri comportamenti prescrittivi. Il Controllo di Gestione della ASL ha evidenziato una diminuzione complessiva del 29% della prescrizione degli esami in oggetto, con un range per i singoli esami fra 10 e 56%, nonché una diminuzione complessiva del 15,59% di tutte le richieste di esami di laboratorio.Introduction. Following an act of Piemonte region about the appropriateness of lab test orders, a project of blended education (front and “learning on the job” education) was designed and implemented, with the aim of increasing the knowledge and awareness of General Practitioners (GP) about the appropriateness of orders of a set of lab tests (PSA, VES, PCR, tests for risk assessment before estro-progestinic medication). The main expected outcome was a change in order habits, with a decrease in the number of inappropriate orders. A “halo effect” was expected as well, showed by a decrease in orders of other lab tests than the ones addressed by the educational program. Methods. The project was designed according to the nine phases of PRECEDE-PROCEED model, particularly addressed to identify effective assessment models for interventions of improvement of health and to assist their implementation and evaluation. All 430 GPs of the local Health Trust ASL TO3 were involved and joined the project, organized in 28 local teams of about 20 members each. The educational program was held in 2012 and was based on two class general meetings (introduction of the project, guidelines for the appropriateness of orders, interim report on the activities of local teams, final report on results and suggestions), intertwined with local team meetings, in which the members of the teams reported about the audit of their behavior and about the mechanisms they identified as a cause of inappropriate ordering. Many of the teams displayed the characteristics of community of practice, with a reflective and active attitude. Results. At the end of the project the orders addressed by the educational program decreased overall of 29%, with the decrease of single exams ranging from 10 to 56%. This decrease corresponded to a decrease of € 523,471 of cost. Many feedback emerged from the local teams, pointing to the influence that the dispositions from consultants had in the process of request of lab tests. As a by-product, data from the ASL TO3 management control office showed a decrease of 15.59% of all lab tests in 2012