Overuse of upper gastrointestinal endoscopy in a country with open-access endoscopy: a prospective study in primary care.

Details

Serval ID
serval:BIB_873
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Overuse of upper gastrointestinal endoscopy in a country with open-access endoscopy: a prospective study in primary care.
Journal
Gastrointestinal endoscopy
Author(s)
Froehlich F., Burnand B., Pache I., Vader J.P., Fried M., Schneider C., Kosecoff J., Kolodny M., DuBois R.W., Brook R.H., Gonvers J.J.
ISSN
0016-5107
ISSN-L
0016-5107
Publication state
Published
Issued date
1997
Peer-reviewed
Oui
Volume
45
Number
1
Pages
13-9
Language
english
Abstract
BACKGROUND: This prospective observational study was aimed at evaluating the appropriateness of use of upper gastrointestinal endoscopy (UGE) in primary care in a country with open access to and high availability of the procedure. METHODS: Outpatients were consecutively included in two clinical settings: Setting A (20 primary care physicians during 4 weeks) and B (university-based outpatient clinic during 3 weeks). In patients undergoing UGE, appropriateness of referral was judged by explicit Swiss criteria developed by the RAND/UCLA panel method. RESULTS: Patient visits (8135) were assessed. Six hundred eleven patients complained of upper gastrointestinal symptoms. Physicians decided to perform UGE in 63 of these patients. Twenty-five (40%) of the endoscopies were rated appropriate, 7 (11%) equivocal, and 31 (49%) inappropriate. Overuse of UGE occurred in 5.1% (setting A: 4.7%; setting B:6.5%; p = 0.39) of the patients who presented with upper gastrointestinal symptoms. The decision to perform UGE in previously untreated dyspeptic patients was the most common clinical situation resulting in overuse. CONCLUSIONS: Inappropriate use of UGE is high in Switzerland. However, to better reflect primary care decision making, overuse should be related not only to patients referred for a medical test, but also to the number of patients who complain of the symptoms that would be investigated by the procedure.
Keywords
Adolescent, Adult, Aged, Endoscopy, Gastrointestinal, Evaluation Studies as Topic, Female, Gastrointestinal Diseases, Health Services Misuse, Humans, Male, Middle Aged, Primary Health Care, Prospective Studies, Switzerland, Unnecessary Procedures
Pubmed
Web of science
Create date
19/11/2007 12:47
Last modification date
20/08/2019 14:46
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