OVERUSE OF UPPER GASTROINTESTINAL ENDOSCOPY IN A COUNTRY WITH OPEN-ACCESS ENDOSCOPY - A PROSPECTIVE-STUDY IN PRIMARY-CARE

Background: This prospective observational study was aimed at evaluati ng the appropriateness of use of upper gastrointestinal endoscopy (UGE ) in primary care in a country with open access to and high availabili ty 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). I n patients undergoing UGE, appropriateness of referral was judged by e xplicit Swiss criteria developed by the RAND/UCLA panel method. Result s: Patient visits (8135) were assessed. Six hundred eleven patients co mplained of upper gastrointestinal symptoms. Physicians decided to per form 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 sym ptoms. The decision to perform UGE in previously untreated dyspeptic p atients was the most common clinical situation resulting in overuse. C onclusions: Inappropriate use of UGE is high in Switzerland. However, to better reflect primary care decision making, overuse should be rela ted not only to patients referred for a medical test, but also to the number of patients who complain of the symptoms that would be investig ated by the procedure.