Overuse of upper gastrointestinal endoscopy in a country with open-access endoscopy : a prospective study in primary care.
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.
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.
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.
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.
Mots-clés Pascal : Endoscopie, Appareil digestif, Extrémité supérieure, Augmentation, Prescription, Etiologie, Symptomatologie, Accès libre, Etude statistique, Homme, Suisse, Europe, Appareil digestif pathologie
Mots-clés Pascal anglais : Endoscopy, Digestive system, Upper extremity, Increase, Prescription, Etiology, Symptomatology, Open access, Statistical study, Human, Switzerland, Europe, Digestive diseases
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0146691
Code Inist : 002B30A03A. Création : 21/05/1997.