Politica sanitaria e salute occupazionale: strumenti e metodi per l’assicurazione della qualità e dell’appropriatezza degli interventi.

«Health policy and occupational health:tools and methods to assure quality and appropriateness ofinterven- tions».Background:Although all health care organizations and professionals are encouraged to follow the explicit aim of reducing the burden of illness,accidents and disability,there is increasing pressure on health professionals to ensure that the practice be based on a quality standard and on evidence ofappropriateness.Objectives and Meth- ods:The paper aims to focus on both the concept and dimensions of appropriateness (a complex issue with various dimensions and definitions) and on the different research and practice models aimed at search,analysis and synthe- sis of the best available evidence to be applied in the decision process of health and medical practice. Literature analysis has been carried out to find available tools and methods to identify,implement and monitor the evidence of efficacy in health care systems and services. Results: Most definitions of appropriateness address a number of re- quirements. An appropriate practice should be effective (based on sound evidence); efficient (providing that cost is considered) and consistent with the ethical principles and preferences ofthe relevant individual,community or soci- ety.Appropriateness is considered as the next frontier in the development ofhealth care research:there is still limited knowledge, awareness, or research on this aspect. Health Technology Assessment consists of a multidisciplinary ac- tivity based on the systematic examination of technical performance,safety,clinical effectiveness and efficiency,in- cluding socio-economic, legal and ethical aspects. Evidence Based Medicine originates from an individual perspec- tive and aims at using rigorous criteria to obtain the best available evidence in order to provide efficient interven- tions.The Clinical Practice Guidelines,based on both evidence and opinions ofexperts,are intended to assist clini- cal decisions for health professional and providers for the improvement ofprofessional practices and system efficiency, taking into account local customers,health needs and preferences.Conclusions:Several models exist for measuring and evaluating the efficacy ofhealth systems and health services.They can be adapted for evaluating and measuring public and occupational health practices.These tools support good practice through quality-standardized interven- tions aiming at the health protection ofcommunities and individuals.These models,which are presented in a specif- ic framework in which their outcomes and critical factors are evaluated,should be adapted to public and occupation- al health interventions to satisfy implicit and explicit needs of individuals and populations at risk thus assuring their quality and appropriateness.