Tan Y M, Goh K L
Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur.
Med J Malaysia. 2004 Mar;59(1):34-8.
An open access endoscopy system allows for the direct scheduling of endoscopies by non-gastroenterologist physicians without prior gastroenterology consultation. The aim of our study was to examine our practice of open access endoscopy by evaluating the appropriateness of referrals for colonoscopy and to determine whether there were differences depending on the specialty of the referring clinician. The indication for colonoscopy was assessed in 499 consecutive outpatients referred for colonoscopy at University Hospital, Kuala Lumpur over a 12-month period. The American Society of Gastrointestinal Endoscopy (ASGE) guidelines were used to determine the appropriateness of referrals. 80.6% of colonoscopies requested by the gastroenterologist were performed for accepted indications compared to 50.6% of referrals by the primary care physician (p<0.001) and 67.0% of referrals by the surgeon (p=0.006). The rate of colonoscopies generally not indicated was 2.1% for the gastroenterologist, 25.0% for the internist (p=0.002) and 7.5% for the surgeon (p=0.04). The rate of indications not listed in the ASGE guidelines was significantly lower for requests made by gastroenterologists (17.3%) than those requested by primary care physicians (44.2%; p<0.001). Patients who have had prior consultation with the gastroenterologist were significantly more likely to undergo colonoscopy for appropriate indications than among patients who were referred through an open access system. The rate of inappropriate indications for colonoscopy was also significantly lower when the gastroenterologist made the referral. A substantial proportion of colonoscopies (25.4%) was performed for indications not listed in the ASGE guidelines.
开放式内镜检查系统允许非胃肠病学医生在无需事先咨询胃肠病学专家的情况下直接安排内镜检查。我们研究的目的是通过评估结肠镜检查转诊的适宜性来审视我们的开放式内镜检查实践，并确定根据转诊临床医生的专业是否存在差异。在12个月期间，对吉隆坡大学医院连续转诊进行结肠镜检查的499例门诊患者的结肠镜检查指征进行了评估。采用美国胃肠内镜学会（ASGE）指南来确定转诊的适宜性。胃肠病学专家要求进行的结肠镜检查中，80.6%是基于可接受的指征进行的，相比之下，初级保健医生转诊的比例为50.6%（p<0.001），外科医生转诊的比例为67.0%（p=0.006）。胃肠病学专家进行的结肠镜检查中，一般无指征的比例为2.1%，内科医生为25.0%（p=0.002），外科医生为7.5%（p=0.04）。胃肠病学专家提出的请求中，未列入ASGE指南的指征比例（17.3%）显著低于初级保健医生提出的请求（44.2%；p<0.001）。与通过开放式系统转诊的患者相比，事先咨询过胃肠病学专家的患者因适当指征接受结肠镜检查的可能性显著更高。由胃肠病学专家进行转诊时，结肠镜检查不适当指征的比例也显著更低。相当一部分结肠镜检查（25.4%）是基于未列入ASGE指南的指征进行的。
