Underutilization of upper gastrointestinal endoscopy.

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State: Public
Version: author
Serval ID
serval:BIB_2651
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Underutilization of upper gastrointestinal endoscopy.
Journal
Gastroenterology
Author(s)
Froehlich F., Pache I., Burnand B., Vader J.P., Fried M., Kosecoff J., Kolodny M., DuBois R.W., Brook R.H., Gonvers J.J.
ISSN
0016-5085
ISSN-L
0016-5085
Publication state
Published
Issued date
1997
Peer-reviewed
Oui
Volume
112
Number
3
Pages
690-7
Language
english
Abstract
BACKGROUND & AIMS: Efforts to reduce costs in health care may raise concerns about underuse of medical procedures. This study prospectively assessed underuse of upper gastrointestinal endoscopy in a cohort of patients in whom we have recently published data on overuse of endoscopy. METHODS: Underuse was identified by formal necessity criteria for endoscopy, obtained by an explicit panel process. Outpatients were consecutively included in two clinical settings. Setting A consisted of 20 primary care physicians and 7215 patient visits that occurred within 1 month. Setting B consisted of 920 visits that occurred during 3 weeks at an outpatient clinic. RESULTS: During these 8135 visits, 611 patients complained of upper digestive symptoms; 63 of them underwent endoscopy. Underuse was identified in 72 patients (11.8%). The two clinical situations mainly responsible for underuse of endoscopy were uninvestigated peptic symptoms resistant to treatment and dysphagia. At first follow-up, 29 of the patients with initial underuse still fulfilled criteria of necessity (underuse rate, 4.7%). One-year follow-up showed underuse of endoscopy in 5 patients. CONCLUSIONS: This prospective evidence shows that underuse of a medical procedure exists. The estimated overuse and underuse of endoscopy in this cohort were approximately equal (5%). Improving quality of care will require reductions of both overuse and underuse of medical procedures.
Keywords
Adolescent, Adult, Aged, Endoscopy, Gastrointestinal, Female, Health Care Costs, Humans, Male, Middle Aged, Prospective Studies, Quality of Health Care
Pubmed
Web of science
Create date
19/11/2007 12:23
Last modification date
20/08/2019 13:05
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