APPROPRIATENESS OF REFERRALS FOR OPEN-ACCESS ENDOSCOPY - HOW DO PHYSICIANS IN DIFFERENT MEDICAL SPECIALTIES DO

Background: Open-access endoscopy allows nongastroenterologist physici ans the opportunity to directly schedule elective common endoscopic pr ocedures for their patients without having them first examined in the gastrointestinal clinic. There are few data as to whether nongastroent erologist physicians in the United States schedule patients for approp riate indications. Objectives: To examine our practice to see whether patients undergoing open-access endoscopy were scheduled for appropria te indications and to see whether there were differences among physici ans in various medical specialties. Methods: We prospectively tracked 310 consecutive patients scheduled for open-access esophagogastroduode noscopy (EGD) and colonoscopy by nongastroenterologist physicians over a 9-month period in our academic practice setting to determine whethe r the indications for performing the procedures were appropriate. The American Society for Gastrointestinal Endoscopy criteria (revised in 1 992) were used as the standard for comparison. Results: Primary care p hysicians (family practitioners and general internists) did a superior job of scheduling patients for appropriate indications for EGD and co lonoscopy than did non-primary care physicians (internal medicine subs pecialists and surgeons): 97.0% vs 81.3% for EGD (P=.04) and 84.9% vs 66.1% for colonoscopy (P=.02), respectively. Conclusions: Primary care physicians were significantly more likely to schedule patients for op en-access EGD and colonoscopy for appropriate indications than were no n-primary care physicians. The frequency of inappropriate indications for colonoscopy referrals was greater than for EGD. The reasons for th e differences among primary care physicians, surgeons, and internal me dicine subspecialists require further exploration.