The Lombardy Court of Auditors, through an analytical examination (represented in the text of the sentence) of individual prescriptions made on certain patients, sentenced a general practitioner to pay 2,840.10 euros for unreasonable prescription of medicines charged to the National Health Service . Prescribing a drug is appropriate if its efficacy is proven in the specific indication and recognized in the technical data sheet and if its adverse effects are "acceptable" compared to the benefits. These characteristics, which describe the clinical and professional appropriateness, must be integrated by the health and management aspect, which also considers the effectiveness of the intervention in the populations and the "consumption" of resources that it entails. Therefore, in order for the prescription of a drug to be appropriate, it is necessary that: the expected or probable benefits on the basis of evidence of efficacy are greater than the possible negative effects and discomforts deriving from its use (favourable benefit/risk ratio); the cost or the certain use of resources that derives from it is equal to or lower than that of other interventions of equal effectiveness or in relation to the benefits that other decisions would allow to achieve by combining the same amount of resources differently; patient preferences and expectations are respected. The doctor chooses the most appropriate drug taking into account the results of clinical studies and after evaluating whether their conclusions are valid and applicable to the clinical reality of the individual patient, who must be correctly diagnosed. In drawing this deduction, the doctor must integrate the data of the dutiful knowledge of the results of the scientific literature with the specific characteristics of the individual patients, such as the pharmacological history, drug interactions, comorbidity and polytherapies, and must interact with their idea of life, with lifestyle, values, spirituality and individual history. The National Health System [SSN] reimburses treatments on the basis of demonstrated efficacy in clinical studies and economic criteria. In other words, the NHS chooses drugs that demonstrate an advantage in selected populations at acceptable costs. The general practitioner is therefore called to evaluate according to the law and to decide whether the most appropriate solution for public health is applicable to the clinical reality of the individual patient. If the patient satisfies these characteristics, the treatment is prescribable and reimbursable, and this is considered fair and correct. (Lawyer Ennio Grassini – www.dirittosanitario.net)
DoctorNews – 22 January 2019
