Efficacia teorica e reale impatto dei programmi di prevenzione: per una scelta pi razionale degli interventi di sanità pubblica

Evidence Based Prevention is becoming increasingly important to guide the policy-makers to choose preventive interventions to be offered to the population. Sometimes however the impact of an intervention in real conditions (effectiveness) may be smaller than the efficacy estimated in studies conducted in experimental settings. This can be due for example to suboptimal coverage of the intervention or to poor compliance of the involved subjects. Regrettably, this aspect is rarely taken into account in the planning of preventive interventions. To evaluate the discrepancy between efficacy and effectiveness of prevention programs we used as examples two interventions for smoking cessation currently available in Italy: 1) Interventions offered by Smoking Cessation Centers; 2) "Minimal Advice" provided by family doctors.