TESTS, DRUGS AND PRESCRIPTIONS:

let's say your opinion!

Franca Braga Altroconsumo

Paola Mosconi Partecipasalute - Laboratory for medicalresearch and consumer involvement, IRCCS Mario Negri

Altroconsumo is an indipendent consumer association set up in Milan

in 1973. It is member of Beuc (the European consumer organization), and ofConsumers International (220 associations of 115 nations).

Some figures (2015): 373.000 members, 394 public partecipations, more than6.200 media presences, about 18 millions visits to altroconsumo.it, 28.000followers on twitter, more than 300.000 like on facebook, 7 magazines

IRCCS Mario Negri is the first private Italian foundation dedicated

to biomedical research. The Laboratory for medical research and consumersinvolvement promotes research activities aimed to developing theparticipation of citizens and patients and their representatives to the decisionsprocess regarding health. Areas of interest are: development of information and training program to allow dealing with themedical and scientific issues testing methods of involvement, as consensus conferences, citizens' juries,surveys on drugs, research priorities, diagnostic tests and screening

Who is who

The story of this survey

Slow Medicine launched in 2012 the project “Doing more does not mean doingbetter”, since the beginning health professionals, general population/patientswere involved

General population/patients have an active role in the project. They collaboratefor the development of laypeople-friendly material about overused tests andtreatments, as well as in widely disseminating the culture that “Doing more doesnot mean doing better” and that less healthcare can often result in better health

Altroconsumo and PartecipaSalute-IRCCS Mario Negri are among the mainpartners of the project, and together with Inversa Onlus and Federazione per ilSociale e la Sanità Bolzano, are the voice of general population, patients andtheir representatives

When the FNOCEO survey was launched among doctors,PartecipaSalute proposed to Altroconsumo to carried out thesurvey

TESTS, DRUGS AND PRESCRIPTIONS: let's say your opinion!

First draft Second draft

Pilot test

Final version

17 questionsPatient-doctor relationship: behaviors (2)

Test/drug not necessary: requested or prescribed (6)Opinion towards unnecessary tests and drugs (2)

Characteristics of respondents (7)

The questionnaire

Online survey, VoceAttiva panel (6.304), not-members of AltroconsumoMarch 2016, 1.019 respondents, sample weighted in order to respect thedistribution of the national population by gender, age and geographical area

Altroconsumo sample

Online survey on the PartecipaSalute website disseminated through e-maillists, articles published on websites, lay journals, bulletins, and facebook

PartecipaSalute sample

February-May 2016, 914 responders: 70% female, 52 (19-85) mean age, 55%high level education, 62% North, and 40% in the past two years didactivities as volunteer in groups of patients or health protection of citizens

I ask for information, treatments and 54% 56% 64%alternatives, then we decide together

After hearing the doctor’s opinion, 19% 32% 23%I take the final decision (+/- info)

I let the physician decide all 26% 12% 13%necessary treatments

When you visit the doctor, which of these behaviors do you usually adopt?

Yes, and the doctor answers me most of the time 79% 74% 79%

Yes, but the doctor rarelyresponds enough 9% 11% 9%

No, usually the doctor does not have enough time 8% 13% 10%

I almost never ask questions 3% 3% 2%

When you visit the doctor, are you able to ask all the questions you think are important?

Never 39% 45%Sometimes 61% 51%Most of the time/always <1% 4%

Over the last 12 months, has it ever happened that you asked a doctor to prescribe you a test/drug that he

did not consider necessary?

What was your reaction?I gave up the test/drug 75% 70%I insisted until the doctor has prescribed 19% 17%I have turned to another doctor 6% 13%

Did the doctor explain why he did not think this prescription was necessary? Yes 91% 86%

Never 73% 64%Sometimes 25% 31%Most of the time/always 2% 5%

Over the last 12 months, has it ever happened that a doctorprescribed a test /drug that you felt you did not need?

What was your reaction?I followed still the indication 45% 29%

I did not follow the doctor’s advice and I have not asked for a second opinion 38% 37%

I turned to another doctor fora second opinion 17% 34%

Do you think this is a problem for the health service? I've never heard of 10% 5%No 9% 12%Yes 80% 83%

In recent years, often we hear about unnecessary drugs,tests or surgery used in medical practice withoutproven utility or benefit for the patients

What is the main reason for you to consider this a problem? It is a waste of money 55% 42%It can be a risk for patients 18% 25%It makes the waiting lists longer 25% 18%Other 2% 15%

The representativeness of respondents: online survey, different methodsof recruitment with some selection bias. Even if the 2 samples cannot bedirectly compared, they both point out some patterns of patient behavior:

• The patient-physician relationship seems good in term of askingquestions, and receiving explanations. Most of respondents adopt anactive role in the decision-making process

• Doctor saying that a test/drug is not necessary: happened to 2/3 of therespondents; the doctor explained the reasons, and more than 70% ofresponders follows the doctor’s advice

• Patient saying that a test/drug is not necessary: happened to more 1/4of the respondents

• Most of respondents hear about unnecessary tests, drugs, or surgeryused in medical practice without proven utility or benefit for thepatients. Most considered this a problem of waste of money but not only

Points for discussion

Thanks to associations promoting the survey: Acli Treviso, ADPMI onlus, AIFP, Ails,AISTOM Nazionale, Alleati per la Salute, Andos nazionale, Animass-Sjogren, AsSisAssociazione Studi e Informazioni sulla Salute, Associazioni Diabetici Clad, AssociazioneSerena, Associazione Diabetici prov Mi, Associazione RMR Onlus, Cibo Amico onlus,FederASMA e Allergie Onlus, Federconsumatori Cefalù, Federazione per il Sociale e laSanità della provincia autonoma di Bolzano, Fondazione Pofferi, GILS, Inversa Onlus,Lampada di Aladino, Semi per la Sids

The working group