ENDOSCOPISTS OPINIONS OF INDICATIONS FOR UPPER GASTROINTESTINAL ENDOSCOPY

OBJECTIVE: To determine whether endoscopists and general internists ag reed with the characterization of appropriateness for endoscopy of var ious clinical scenarios, as previously reported by the RAND Corporatio n. DESIGN: Mail survey. STUDY SAMPLE: All endoscopists in-western Cana da and a random sample of general internists who did not endoscopy. ME THODS: Questionnaires were sent to 179 endoscopists in western Canada who were asked to rate the 53 scenarios for endoscopy on a nine point scale ranging from most appropriate to most inappropriate. A similar q uestionnaire was sent to 39 general internists practising in the provi nce of Alberta. RESULTS: Response rate was 72% of endoscopists (n = 12 8) and 64% of general internists (n = 25). Among the endoscopists, the re was agreement with the RAND classification for 32 scenarios. All 18 indications previously thought to be appropriate were considered to b e appropriate. However, endoscopists agreed with only six of 16 equivo cal and eight of 19 indications considered inappropriate. Discrepancie s were reviewed by five experienced-endoscopists and most appeared to be related to a concern regarding possible malignancy linked in part w ith the definition of failure to respond to medical therapy; and to a refusal to request a barium meal before endoscopy. Among general inter nists, there was agreement with RAND in 26 scenarios. When the appropr iateness rankings of endoscopists and general internists were compared , there was agreement in 40 of 53 scenarios. Significant discrepancies in ratings were identified in scenarios in which barium studies were- described as being normal, known or not done. CONCLUSIONS: The equivoc al and inappropriate ratings developed by the RAND Corporation are not uniformly accepted by the endoscopy community or general internists. Use of the RAND indications for assessing quality assurance-can be cha llenged.