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111 Information ‘pills’ for doctors and citizens in italy: a scientific communication project to contrast overdiagnosis and overtreatment
  1. Luana Caselli1,
  2. Maria Congedo2,3,
  3. Alberto Donzelli1,
  4. Luca Iaboli4,5
  1. 1Allineare Sanità e Salute, Milano, Italy
  2. 2Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
  3. 3Nograzie, Trieste, Italy
  4. 4Nograzie, Modena, Italy
  5. 5Azienda Sanitaria Locale, Modena, Italy


Objectives Reliable and accurate public health information is essential to get high-level health care.

General access to more information is a double-edged sword: though unarguably positive, it comes from information sources that are largely unregulated, boosting healthcare consumerism, a driver for over-diagnosis and over-treatment.

The Italian information and educational tool Pillole questions consumers’ false believes, rooted in physicians even more than in patients.

For instance, information about dementias is subject to mass media recurrent claim of ‘epidemic’ diffusion without any mention of epidemiological data reporting a reduction trend for incidence and prevalence in several western countries in last decades. This inappropriate information causes a demanding attitude for evaluation.

Uncertainty on the diagnostic value of biomarkers and neuroimaging in cognitive impairment can lead to identification of a supposed risk condition that is untreatable (BMJ 2013; 347: f5125), but triggers a cascade of prescriptions, monitoring and unproven therapies.

Information tools can be improved.

Method Pillole are scientific up-to-date evidence-based information sheets, designed around a strategic public health thought. Since 2004 they are issued in two formats:

  • Good clinical practice Pillole, for health professionals, aiming to give greater value to primary and specialist medical care, taking the point of view of a universalistic and supportive NHS.

  • Health education Pillole, designed for citizens, aiming to inform on the basic elements of health self–management and acquire better skills to put them into practice, provide a critical sense about the limits, risks and costs of current treatments and the availability of effective alternatives, make good use of health services, do not urge physicians to irrational consumerist prescriptions.

In addition, recently we designed a third experimental format, using a short plain text with appealing editing to give clear information at a glance, aimed to increase diffuse knowledge among those who have no time to read extensively.

Results For example, some issues of Pillole deal with dementias epidemiology (Pillole di Educazione Sanitaria 119–120/2016, Pillole di Buona Pratica Clinica 141–142/2017) and prevention measures (Pillole di Educazione Sanitaria 67/2011 and 121/2016). As mass media use to report an ‘epidemic’ spread (eg Quotidiano Sanità 13.03.2017, La Repubblica 20.09.2017), favouring diffuse fear for cognitive impairment, Pillole present epidemiological data and suggestions to prevent cognitive impairment, reduce alarmism, contrast over-investigation and prevent over-diagnosis, disease mongering and useless treatments. Pillole can be used by health professionals to communicate with citizens, patients and their family members; general practitioners can use Pillole to update their own knowledge while they look for documented answers for their patients. The three formats help in using reference-based information at different language and target levels, but founded on the same data and drawn up with the same accuracy.

Conclusions Diffusion of Pillole among citizens in the physician office can help health professionals to discuss with patients and their families before prescribing treatments, tests, procedures and products in order to share uncertainty about results and reducing overdiagnosis and hence overtreatment. Besides, the diffusion of prevention strategy can help in empowering citizens to identify and reduce risks. In conclusion, Pillole can • contribute to a better understanding of the limits of diagnostic tools in use, • reduce the demanding attitude for exams and medical treatments, • redirect towards useful and safe preventive actions.

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