Overuse and underuse of colonoscopy in a European primary care setting

被引:41
|
作者
Vader, JP
Pache, I
Froehlich, F
Burnand, B
Schneider, C
Dubois, RW
Brook, RH
Gonvers, JJ
机构
[1] Univ Lausanne, Inst Social & Prevent Med, CH-1005 Lausanne, Switzerland
[2] Univ Lausanne, Dept Gastroenterol, CH-1005 Lausanne, Switzerland
[3] Univ Lausanne, Med Outpatient Dept, PMU CHUV, CH-1005 Lausanne, Switzerland
[4] RAND Corp, Santa Monica, CA USA
[5] Protocare Sci, Santa Monica, CA USA
[6] Univ Calif Los Angeles, Dept Med, Los Angeles, CA USA
关键词
D O I
10.1067/mge.2000.108716
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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.
引用
收藏
页码:593 / 599
页数:7
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