Overuse and underuse of colonoscopy in a European primary care setting.

Détails

ID Serval
serval:BIB_14339
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Overuse and underuse of colonoscopy in a European primary care setting.
Périodique
Gastrointestinal endoscopy
Auteur⸱e⸱s
Vader J.P., Pache I., Froehlich F., Burnand B., Schneider C., Dubois R.W., Brook R.H., Gonvers J.J.
ISSN
0016-5107
Statut éditorial
Publié
Date de publication
2000
Peer-reviewed
Oui
Volume
52
Numéro
5
Pages
593-99
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't - Publication Status: ppublish
Résumé
BACKGROUND: Efforts to decrease overuse of health care may result in underuse. Overuse and underuse of colonoscopy have never been simultaneously evaluated in the same patient population. METHODS: In this prospective observational study, the appropriateness and necessity of referral for colonoscopy were evaluated by using explicit criteria developed by a standardized expert panel method. Inappropriate referrals constituted overuse. Patients with necessary colonoscopy indications who were not referred constituted underuse. Consecutive ambulatory patients with lower gastrointestinal (GI) symptoms from 22 general practices in Switzerland, a country with ready access to colonoscopy, were enrolled during a 4-week period. Follow-up data were obtained at 3 months for patients who did not undergo a necessary colonoscopy. RESULTS: Eight thousand seven hundred sixty patient visits were screened for inclusion; 651 patients (7.4%) had lower GI symptoms (mean age 56.4 years, 68% women). Of these, 78 (12%) were referred for colonoscopy. Indications for colonoscopy in 11 patients (14% of colonoscopy referrals or 1.7% of all patients with lower GI symptoms) were judged inappropriate. Among 573 patients not referred for the procedure, underuse ranged between 11% and 28% of all patients with lower GI symptoms, depending on the criteria used. CONCLUSIONS: Applying criteria from an expert panel of nationally recognized experts indicates that underuse of referral for colonoscopy exceeds overuse in primary care in Switzerland. To improve quality of care, both overuse and underuse of important procedures must be addressed.
Mots-clé
Colonoscopy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Primary Health Care, Prospective Studies, Switzerland
Pubmed
Web of science
Création de la notice
19/11/2007 12:06
Dernière modification de la notice
20/08/2019 12:42
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