Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California 93102-0689, USA.
J Surg Educ. 2011 Jan-Feb;68(1):32-5. doi: 10.1016/j.jsurg.2010.08.006. Epub 2010 Nov 5.
To determine the clinical and educational value of a new model for providing endoscopy for medically indigent patients.
A model can be developed at minimal cost to provide essential endoscopy services for underserved patients while providing resident education.
In our community, there was limited access to endoscopy for indigent patients, and surgical resident endoscopy experience was inadequate. To address these problems, a new endoscopy program was developed. Procedures were performed during underused times in a hospital endoscopy clinic. Endoscopies were performed on patients referred from the public health clinics. All procedures were performed by senior surgical residents supervised by attending endoscopists. The data were collected over 30 months. Colonoscopies were performed for both diagnostic and screening purposes.
In all, 205 colonoscopies, 65 upper endoscopies, and 14 combined endoscopies were performed.
Positive findings on endoscopy were documented. The cost-effectiveness was calculated.
Of 205 colonoscopies, 35% had positive findings. Sixty-six (32%) patients had polyps and 6 (3%) patients had carcinomas. Of 65 upper endoscopies, 34 (55%) patients had positive findings. Thirty (47%) patients had moderate to severe gastritis/esophagitis or ulcers, 2 (3%) patients had esophageal varices, 2 (5%) patients had carcinomas, 10 (15%) patients had positive H. pylori biopsies, and 2 (3%) patients had Barrett's esophagus. The program incurred minimal incremental costs, and large cost savings were realized in prevention and early detection of colon and gastric carcinomas.
Our 30-month experience resulted in clinical benefits to patients at minimal incremental cost while reducing future medical costs by preventing and detecting disease. Surgical residents received essential training.
确定为贫困患者提供内窥镜检查的新模式的临床和教育价值。
可以以最低成本开发一种模型，为服务不足的患者提供基本的内窥镜服务，同时提供住院医师教育。
在我们的社区，贫困患者获得内窥镜检查的机会有限，且外科住院医师的内窥镜检查经验不足。为了解决这些问题，开发了一种新的内窥镜检查计划。在医院内窥镜检查诊所的未充分利用时间进行手术。从公共卫生诊所转介的患者进行内窥镜检查。所有程序均由高级外科住院医师在主治内窥镜医师的监督下进行。数据收集了 30 个月。进行结肠镜检查用于诊断和筛查目的。
共进行了 205 例结肠镜检查，65 例上内窥镜检查和 14 例联合内窥镜检查。
205 例结肠镜检查中，35%有阳性发现。66 例（32%）患者有息肉，6 例（3%）患者有癌。65 例上内窥镜检查中，34%（55%）患者有阳性发现。30 例（47%）患者有中度至重度胃炎/食管炎或溃疡，2 例（3%）患者有食管静脉曲张，2 例（5%）患者有癌，10 例（15%）患者有阳性 H. pylori 活检，2 例（3%）患者有 Barrett 食管。该计划仅产生了最低的增量成本，并且通过预防和早期发现结肠癌和胃癌，实现了大量的成本节约。
我们 30 个月的经验为患者带来了临床收益，而成本仅略有增加，同时通过预防和检测疾病降低了未来的医疗成本。外科住院医师接受了必要的培训。
