La variabilità della pratica clinica in Italia.

[Autom. eng. transl.] In Italy, variability in clinical practice is common and represents one of the major concerns for patients, professionals and decision makers. Through the selection of three clinical areas (pregnancy and childbirth, treatment with Percutaneous Transluminal Coronary Angioplasty - PTCA in patients with acute myocardial infarction and diabetes management), the authors underline that there is, in each of the three areas, an unjustified variability, which it cannot be explained only by the frequency / severity of the illness or other factors related to the patient. In order to describe the variability among the Italian regions, the authors chose both process indicators (eg volumes) and results (eg mortality, complications). The incidence of caesarean sections is particularly high in Italy compared to other European countries. More than elsewhere, the pressures linked to the so-called defensive medicine, the planning of childbirth for reasons of convenience of both doctors and patients and, more generally, changes in the doctor-patient relationship are probably responsible for inducing inappropriate practices. Furthermore, important variations are observed at an intraregional level, in particular as regards the type of hospital (private, public and university). Even the timely execution of PTCA is characterized by an interregional variability that once again cannot be explained only by clinical factors. In particular, we observe an extreme variability between structures belonging to the same Region in the percentage of PTCA performed within 48 hours. Regarding diabetes, significant differences were observed in the consumption of drugs, in the metabolic control of patients and in hospitalizations for short and long-term complications, which are considered a proxy of patient management at the territorial level. This management generates inequalities in the health field, with significant effects on the financial and allocative sustainability of the systems, also considering the high prevalence of the pathology