F. Froehlich et al., OVERUSE OF UPPER GASTROINTESTINAL ENDOSCOPY IN A COUNTRY WITH OPEN-ACCESS ENDOSCOPY - A PROSPECTIVE-STUDY IN PRIMARY-CARE, Gastrointestinal endoscopy, 45(1), 1997, pp. 13-19
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.