3398 Effect of an educational intervention program on gastrointestinal endoscopic overuse in primary care physicians.

Abstract

Open access to gastrointestinal (GI) endoscopy for general practitioners (GP) has been associated with a high rate of inappropriate indications. Objective. To determine the impact of an educational intervention program on the overuse of GI endoscopic procedures indicated by GP. Methods. During a six month period an educational program was implemented by a team of gastroenterologists (GAS) to update GP from seven primary health care centers on the main indications of upper GI endoscopy (UGE), sigmoidoscopy and colonoscopy. In addition, instructions were given to these doctors for submitting patients to an open access endoscopic unit that included: written and signed informed consent, detailed information about the procedure, and accessibility for conscious sedation. Thereafter, the overuse of GI endoscopic procedures indicated by GP was prospectively evaluated during a six months period and compared with that obtained by GAS working at a teaching hospital. Indications were determined from clinical records and a brief interview with the patient prior to endoscopy. Two experienced GAS blindly evaluated the indication for each procedure by means of the ASGE 97 appropriate indications guide for GI endoscopy. Results: 334 patients were included in the study: UGE was performed in 207 patients, whereas lower GI endoscopy (LGE) was done in the remained 127 patients (82 sigmoidoscopies and 45 colonoscopies). UGE or LGE overuse rate was not statistical different between GP and GAS (18% and 26% vs 23% and 14%, respectively). The main inappropriate indications for gastroscopy were: absence of previous symptomatic treatment and follow up of benign lesions for both groups of physicians. Inappropriate colonoscopy was indicated by GP for typical rectal bleeding and chronic symptoms, whereas GAS wrongly indicated sigmoidoscopy for hematoquezia evaluation. Conclusions. Gastrointestinal endoscopy overuse rate for primary care physicians was identical to that of specialized physicians when a previous educational intervention program was implemented. In both groups of physicians inappropriate indications were similar for gastroscopy but differed from sigmoidoscopy or colonoscopy. Open access to gastrointestinal (GI) endoscopy for general practitioners (GP) has been associated with a high rate of inappropriate indications. Objective. To determine the impact of an educational intervention program on the overuse of GI endoscopic procedures indicated by GP. Methods. During a six month period an educational program was implemented by a team of gastroenterologists (GAS) to update GP from seven primary health care centers on the main indications of upper GI endoscopy (UGE), sigmoidoscopy and colonoscopy. In addition, instructions were given to these doctors for submitting patients to an open access endoscopic unit that included: written and signed informed consent, detailed information about the procedure, and accessibility for conscious sedation. Thereafter, the overuse of GI endoscopic procedures indicated by GP was prospectively evaluated during a six months period and compared with that obtained by GAS working at a teaching hospital. Indications were determined from clinical records and a brief interview with the patient prior to endoscopy. Two experienced GAS blindly evaluated the indication for each procedure by means of the ASGE 97 appropriate indications guide for GI endoscopy. Results: 334 patients were included in the study: UGE was performed in 207 patients, whereas lower GI endoscopy (LGE) was done in the remained 127 patients (82 sigmoidoscopies and 45 colonoscopies). UGE or LGE overuse rate was not statistical different between GP and GAS (18% and 26% vs 23% and 14%, respectively). The main inappropriate indications for gastroscopy were: absence of previous symptomatic treatment and follow up of benign lesions for both groups of physicians. Inappropriate colonoscopy was indicated by GP for typical rectal bleeding and chronic symptoms, whereas GAS wrongly indicated sigmoidoscopy for hematoquezia evaluation. Conclusions. Gastrointestinal endoscopy overuse rate for primary care physicians was identical to that of specialized physicians when a previous educational intervention program was implemented. In both groups of physicians inappropriate indications were similar for gastroscopy but differed from sigmoidoscopy or colonoscopy.