DOES AN OPEN ACCESS SYSTEM PROPERLY UTILIZE ENDOSCOPIC RESOURCES

Background: In an effort to maintain procedure volumes and control con sultation costs, many gastrointestinal endoscopists and primary care p roviders have implemented systems of open access endoscopy. In these s ystems, specialists in digestive diseases perform endoscopy without pr ior consultation. The purpose of this study is to determine if indicat ions for upper endoscopic procedures requested in an open access syste m conform to national practice guidelines and to establish the yield o f diagnostic information relevant for patient care in this system. Met hods: Procedural indications and results for 3715 upper endoscopic pro cedures performed in an open access system were recorded in a computer database. The practice guideline ''Appropriate Use of Gastrointestina l Endoscopy'' (AUGE) of the American Society for Gastrointestinal Endo scopy was used to determine appropriateness of procedural indications. Results: Eighty-four percent of procedures were performed for indicat ions listed in the AUGE, and 59% resulted in findings relevant to pati ent care. Specialists requested endoscopy more frequently for ''approv ed'' indications than did nonspecialists (p = .004) and more frequentl y had findings relevant to patient care (p < .001). Findings relevant to patient care are significantly more frequent for some indications l isted in the AUGE compared to others (p < .001). Conclusions: Adherenc e to practice guidelines can and does occur in an open access system. Specialists request endoscopy more frequently for appropriate indicati ons compared to nonspecialists and have a higher yield of information relevant to patient care. Further refinement and better definition of some indications within the AUGE are needed to increase the clinical u tility of this document.