Variability in Home Mechanical Ventilation Prescription

Prevalence and variability of use of home mechanical ventilators, positive airway pressure and oxygen devices in the Lombardy region, Italy

“…The high number of prescriptions in Lombardy could be related to the number of prescribing centers and their characteristics (presence of a respiratory specialist) ( Table 2). We have confirmed previous data in Catalonia [18] that districts with a high number of Hospitals with a respiratory medicine unit were associated with a greater number of cases (Table 2) while the high variability in prescribing HMV in Lombardy has demonstrated inhomogeneity in the HMV care program. Data on the prevalence of CPAP treatment for sleep apnea in different countries around the world are not clear, probably due to the mixed supply from both private market (not clearly measurable) and the public health organizational system.…”

“…Catalonia (Spain) [18]. Compared to other countries and to Italy as a whole [19], HMV prescription in Lombardy (63/100,000) seems to be the highest ratio published so far in the literature (Table 3).…”

“…On the other hand, the wide variety of diagnoses or patients potentially in need of HMV could also explain the variations observed. The attitude of physicians to ventilation seems in fact to be one of the most important factors behind the variability [18,22]. The high number of prescriptions in Lombardy could be related to the number of prescribing centers and their characteristics (presence of a respiratory specialist) ( Table 2).…”

“…The first reason for this high ratio is that the present data were obtained from crude and sure administrative data not coming from doctors' or hospitals' surveys. Although HMV is not technically complex, decision-making and resolving complications require high skills that justify concentrating the prescription in respiratory centers [18,21] widely distributed among all health Lombardy districts. Another factor that may explain a high variability is the absence of objective evidence-based criteria for starting HMV, especially in obese or COPD patients [18].…”

“…Although HMV is not technically complex, decision-making and resolving complications require high skills that justify concentrating the prescription in respiratory centers [18,21] widely distributed among all health Lombardy districts. Another factor that may explain a high variability is the absence of objective evidence-based criteria for starting HMV, especially in obese or COPD patients [18]. On the other hand, the wide variety of diagnoses or patients potentially in need of HMV could also explain the variations observed.…”