Underutilization of upper gastrointestinal endoscopy

Froehlich, Florian; Pache, Isabelle; Burnand, Bernard; Vader, J.-P.; Fried, Michael; Kosecoff, Jacqueline; Kolodny, Marvin; Dubois, Robert W.; Brook, Robert H.; Gonvers, Jean‐Jacques

doi:10.1053/gast.1997.v112.pm9041229

Cited by 45 publications

(24 citation statements)

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“…We have identified (see table 4) dyspepsia management areas which require greater evidence on application in primary care. In keeping with previous observations [18], our study shows that GPs tend to adopt a more conservative attitude and prescribe less gastroscopies in the follow-up of both gastric ulcer patients and older patients with dyspepsia of recent onset, and that they resist changes in their practice. In the case in point, they probably take advantage of the lack of time restrictions in patient follow-up.…”

Section: Discussionsupporting

confidence: 90%

Effect of Implementation of a Dyspepsia and <i>Helicobacter pylori</i> Eradication Guideline in Primary Care

Cardin¹,

Zorzi²,

Bovo³

et al. 2005

Digestion

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Background: Many international guidelines address appropriateness, prescribing variability and drug-related expenditure in primary dyspepsia management. Aims: To evaluate the impact on general practitioner (GP) practice and healthcare costs of a participatory intervention to modify primary dyspepsia and Helicobacter pylori (Hp) infection management, by standardised implementation of an international guideline in the local setting, through a prospective, controlled before-and-after study. Methods: Primary dyspepsia management was monitored in the Local Health District of Padua; 63 of all 354 local GPs (total patient population: 82,284) took part in a primary-care improvement programme. Measured variables were: mean prescribed gastroscopies/1,000 registered patients, mean expenditure/1,000 registered patients for antisecretories (H₂ blockers) and proton pump inhibitors (PPIs), inter-GP prescribing variability and adherence to guidelines, analysed through prospectively filled-out reports on GP consultations for dyspepsia. A 3-month pre-survey period was compared with a 6-month intervention period following implementation of an agreed guideline. Results: Compared to non-participating GPs, intervention yielded a 30 and 26.4% reduction in H₂-blocker and PPI expenditure, respectively. Application of the guideline led to an upward trend in endoscopy prescriptions, coupled with a 7% increase in appropriate referrals. Intra-group variability marginally decreased; guideline compliance rose slightly. Conclusions: Participatory intervention can reduce prescribing variability among GPs and inappropriate esophagogastroduodenoscopies, lowering related costs. Results may not have been spectacular, but in view of the number of patients involved, they may have an important impact on Local Health District expenditure.

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Section: Discussionsupporting

confidence: 90%

Effect of Implementation of a Dyspepsia and <i>Helicobacter pylori</i> Eradication Guideline in Primary Care

Cardin¹,

Zorzi²,

Bovo³

et al. 2005

Digestion

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“…There is good reason to be proud of our health care system, and the evidence from international studies does not show consistent superiority elsewhere in the world (Gray et al 1990;Pilpel et al 1992;McGlynn et al 1994;Froehlich et al 1997;Meijler et al 1997;Tamblyn et al 1997;Wong et al 1997). The United States is responsible for many important advances in health care technology, and state-of-the-art care is available in both large and small communities throughout the country.…”

Section: Discussionmentioning

confidence: 99%

How Good Is the Quality of Health Care in the United States?

1998

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Studies over the past decade show that some people are receiving more care than they need, and some are receiving less. Simple averages from a number of studies indicate that 50 percent of people received recommended preventive care; 70 percent, recommended acute care; 30 percent, contraindicated acute care; 60 percent, recommended chronic care; and 20 percent, contraindicated chronic care. These studies strongly suggest that the care delivered in the United States often does not meet professional standards. Efforts to measure quality and report routinely on the results to the public at large would allow more definitive assessments of the status of the nation's health care and would enable us to single out the areas in need of improvement.

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“…In prospective trials, primary care providers have been reported to both overuse and underuse endoscopy approximately 5% of the time [10,11]. An example of limitations placed on the use of endoscopy are Upper endoscopy is an integral component in the management of upper gastrointestinal disorders, but it is underutilized because of its high cost and potential complications.…”

Section: Why Is Less Costly Endoscopy Needed?mentioning

confidence: 99%

Unsedated transnasal endoscopy: A safe and less costly alternative

Saeian

2002

Curr Gastroenterol Rep

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Upper endoscopy is an integral component in the management of upper gastrointestinal disorders, but it is underutilized because of its high cost and potential complications. Unsedated transnasal endoscopy (T-EGD) is a relatively new technique using an ultrathin endoscope. Because it is better tolerated than standard upper endoscopy, it is performed with the patient unsedated, thus avoiding the associated costs and complications of conscious sedation. In this review, the technique of T-EGD and its current experience are discussed. In addition, potential future applications, special considerations, and potential pitfalls are reviewed.

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Underutilization of upper gastrointestinal endoscopy

Cited by 45 publications

References 0 publications

Effect of Implementation of a Dyspepsia and <i>Helicobacter pylori</i> Eradication Guideline in Primary Care

Effect of Implementation of a Dyspepsia and <i>Helicobacter pylori</i> Eradication Guideline in Primary Care

How Good Is the Quality of Health Care in the United States?

Unsedated transnasal endoscopy: A safe and less costly alternative

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