Abstract
Open-access colonoscopy (OAC), whereby the colonoscopy is performed without a prior office visit with a gastroenterologist, is affected by inappropriateness which leads to overprescription and reduced availability of the procedure in case of alarming symptoms. The clinical care pathway (CCP) is a healthcare management tool promoted by national health systems to organize work-up of various morbidities. Recently, we started a CCP dedicated to colorectal cancer (CRC), including a colonoscopy session for CRC diagnosis and prevention. We aimed to evaluate the appropriateness, the quality, and the efficiency in the delivery of colonoscopy with the open-access system and a CCP program in the CRC. Quality indicators for colonoscopy in subjects in the CCP were compared to referrals by general practitioners (OAC) or by non-gastroenterologist physicians (non-gastroenterologist physician colonoscopy, NGPC). Attendance rate to colonoscopy was greater in the CCP group and NGPC group than in the OAC group (99%, 99%, and 86%, respectively). Waiting time in the CCP group was shorter than in the OAC group (3.88 ± 2.27 vs. 32 ± 22.31 weeks, respectively). Appropriateness of colonoscopy prescription was better in the CCP group than in the OAC group (92 vs. 50%, respectively). OAC is affected by the lack of timeliness and low appropriateness of prescription. A CCP reduces the number of inappropriate colonoscopies, especially for post-polypectomy surveillance, and improves the delivery of colonoscopy in patients requiring a fast-track examination. The high rate of inappropriate OAC suggests that this modality of healthcare should be widely reviewed.
Highlights
Colorectal cancer (CRC) is the second cause of cancerrelated death in men and women in Western Countries [1, 2]
The diffuse awareness of the crucial role played by prevention and early diagnosis of CRC has led to an increasing prescription of colonoscopy by gastroenterologists and other specialists, and by the general practitioner (GP)
The present study shows that the open-access colonoscopy (OAC) is affected by the lack of timeliness which is at least partly due to the reduced appropriateness of prescription
Summary
Colorectal cancer (CRC) is the second cause of cancerrelated death in men and women in Western Countries [1, 2]. Prevention by fecal occult blood test (FOBT), sigmoidoscopy, and colonoscopy has been proven to reduce mortality and morbidity due to CRC [3, 4]. The diffuse awareness of the crucial role played by prevention and early diagnosis of CRC has led to an increasing prescription of colonoscopy by gastroenterologists and other specialists, and by the general practitioner (GP). The GP plays a key role for subjects with worrisome symptoms or those who, asymptomatic, wish to carry out an investigation for CRC prevention. The GP may prescribe an open-access colonoscopy (OAC) whereby the colonoscopy is performed without a prior office visit with a gastroenterologist [5]. OAC theoretically should facilitate access to an endoscopic procedure
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