UNDERUTILIZATION OF UPPER GASTROINTESTINAL ENDOSCOPY

Background & Aims: Efforts to reduce costs in health care may raise co ncerns about underuse of medical procedures, This study prospectively assessed underuse of upper gastrointestinal endoscopy in a cohort of p atients in whom we have recently published data on overuse of endoscop y. Methods: Underuse was identified by formal necessity criteria for e ndoscopy, obtained by an explicit panel process. Outpatients were cons ecutively included in two clinical settings. Setting A consisted of 20 primary care physicians and 7215 patient visits that occurred within 1 month. Setting B consisted of 920 visits that occurred during 3 week s at an outpatient clinic. Results: During these 8135 visits, 611 pati ents complained of upper digestive symptoms; 63 of them underwent endo scopy. Underuse was identified in 72 patients (11.8%), The two clinica l situations mainly responsible for underuse of endoscopy were uninves tigated peptic symptoms resistant to treatment and dysphagia. At first follow-up, 29 of the patients with initial underuse still fulfilled c riteria of necessity (underuse rate, 4.7%). One-year follow-up showed underuse of endoscopy in 5 patients. Conclusions:This prospective evid ence shows that underuse of a medical procedure exists. The estimated overuse and underuse of endoscopy in this cohort were approximately eq ual (5%). improving quality of care will require reductions of both ov eruse and underuse of medical procedures.