Abstract
BackgroundIn a context of increasing demand and pressure on the public health expenditure, appropriateness of colonoscopy indications is a topic of discussion. The objective of this study is to evaluate the appropriateness of colonoscopy requests performed in a primary care (PC) setting in Catalonia.MethodsCross-sectional descriptive study. Out-patients >14 years of age, referred by their reference physicians from PC or hospital care settings to the endoscopy units in their reference hospitals, to undergo a colonoscopy. Evaluation of the appropriateness of 1440 colonoscopy requests issued from January to July 2011, according to the EPAGE-II guidelines (European Panel on the Appropriateness of Gastrointestinal Endoscopy).ResultsThe most frequent indications of diagnostic suspicion requests were: rectal bleeding (37.46 %), abdominal pain (26.54 %), and anaemia study (16.78 %). The most frequent indications of disease follow-up were adenomas (58.1 %), and CRC (31.16 %). Colonoscopy was appropriate in 73.68 % of the cases, uncertain in 16.57 %, and inappropriate in 9.74 %. In multivariate analysis, performed colonoscopies reached an OR of 9.9 (CI 95 % 1.16–84.08) for qualifying as appropriate for colorectal cancer (CRC) diagnosis, 1.49 (CI 95 % 1.1–2.02) when requested by a general practitioner, and 1.09 (CI 95 % 1.07–1.1) when performed on women.ConclusionsAppropriateness of colonoscopy requests in our setting shows a suitable situation in accordance with recognized standards. General practitioners contribute positively to this appropriateness level. It is necessary to provide physicians with simple and updated guidelines, which stress recommendations for avoiding colonoscopy requests in the most prevalent conditions in PC.
Highlights
In a context of increasing demand and pressure on the public health expenditure, appropriateness of colonoscopy indications is a topic of discussion
Colonoscopy requests have significantly increased over the last years as a consequence to the efficacy shown in the colorectal cancer (CRC) screening. [2, 3]
54.66 % of the requests were issued from primary care centres (PCC)
Summary
In a context of increasing demand and pressure on the public health expenditure, appropriateness of colonoscopy indications is a topic of discussion. The objective of this study is to evaluate the appropriateness of colonoscopy requests performed in a primary care (PC) setting in Catalonia. Most conditions that affect the lower gastrointestinal tract can be diagnosed by colonoscopy, and some therapeutic procedures may be performed simultaneously [1]. Colonoscopy is the most sensitive and specific test to detect adenomas and colorectal cancer (CRC). Colonoscopy requests have significantly increased over the last years as a consequence to the efficacy shown in the CRC screening. Colonoscopy is considered the test of choice in high risk patients (family history of CRC and/or personal history of advanced adenomas, and is the diagnostic confirmation test when the faecal occult blood test (FOBT) is positive [4].
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