Rodney W M, Hocutt J E, Coleman W H, Weber J R, Swedberg J A, Cronin C, Gelb D M, Godreau C J, Bradford C R
University of Tennessee, Memphis-College of Medicine, Department of Family Medicine 38104.
J Am Board Fam Pract. 1990 Apr-Jun;3(2):73-9.
This is the first multisite report of esophagogastroduodenoscopies (EGDs) performed by family physicians. The first 717 EGDs performed by family physicians from 8 separate office practices provide a practical and safe rationale for selected cognitive and psychomotor aspects of continuing medical education after residency training. Although primarily in private practice, these physicians were affiliated with 6 academic institutions. This group of family physicians received training in short courses. The average amount of hands-on training before independent EGD was 8 supervised cases. Cumulatively, these data represent 227 months (18.9 years) of office practice. All cases were collected sequentially from the beginning of each physician's experience, and 454 cases were collected prospectively. Physicians reported excellent patient tolerance. Diagnostic yields were high, and biopsies were performed where appropriate. Pathologists reviewed biopsy specimens from 213 sites. The family physician endoscopic diagnosis agreed with the tissue diagnosis in 188 cases (88 percent). Physicians believed that EGD enhanced management or changed the diagnosis in more than 89 percent of cases. One bleeding complication requiring overnight hospitalization was noted. This complication rate 0.0014 (1/717) compares favorably with published subspecialty complication rates 0.0013 (1.3/1000). These data confirm the ability of some family physicians to perform EGD and suggest that continuation is safe. Biopsy analysis indicates diagnostic accuracy is high. Further study on the cognitive aspects and the defragmentation of care is needed.
这是关于家庭医生进行食管胃十二指肠镜检查（EGD）的首份多中心报告。来自8个不同门诊机构的家庭医生所进行的首批717例EGD，为住院医师培训后的继续医学教育中选定的认知和心理运动方面提供了切实可行且安全的依据。尽管这些医生主要从事私人执业，但他们隶属于6所学术机构。这组家庭医生接受了短期课程培训。在独立进行EGD之前，平均实际操作培训量为8例有监督的病例。累计而言，这些数据代表了227个月（18.9年）的门诊实践。所有病例从每位医生开始执业时就依次收集，其中454例是前瞻性收集的。医生报告患者耐受性良好。诊断率很高，并在适当情况下进行了活检。病理学家审查了来自213个部位的活检标本。家庭医生的内镜诊断与组织诊断在188例（88%）中相符。医生认为，在超过89%的病例中，EGD改善了治疗或改变了诊断。记录到1例需要住院过夜的出血并发症。该并发症发生率为0.0014（1/717），与已发表的专科并发症发生率0.0013（1.3/1000）相比具有优势。这些数据证实了一些家庭医生进行EGD的能力，并表明继续开展是安全的。活检分析表明诊断准确性很高。需要对认知方面和医疗碎片化进行进一步研究。
