基层医疗中消化不良及有警示体征患者早期胃镜检查的实施与评估

Implementation and evaluation of early gastroscopy for patients with dyspepsia and warning signs in Primary Care.

作者信息

García-Alonso Francisco Javier, Hernández Tejero María, Rubio Benito Elvira, Valer Paz, Guerra Iván, García Ceballos Victoria Gema, Noguerol Mar, Llinares Victoria, Bermejo Fernando

机构信息

Servicio de Aparato Digestivo, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España.

出版信息

Gastroenterol Hepatol. 2017 May;40(5):331-338. doi: 10.1016/j.gastrohep.2016.10.004. Epub 2016 Dec 20.

DOI:10.1016/j.gastrohep.2016.10.004

PMID:28010892

Abstract

INTRODUCTION

Dyspepsia is a common disorder in both Primary (PC) and Specialised Care (SC). Gastroscopy is recommended at the start of the study if there are warning signs, although it is not always available in PC.

OBJECTIVES AND METHODS

We developed a pilot project establishing an early gastroscopy programme for patients with dyspepsia and warning signs in PC, subsequently extending it to the entire healthcare area. The aim was to evaluate the requirements, impact and opinion of this service at the PC level. Demographic, symptomatic and endoscopic variables on the patients referred to SC from the pilot centre were recorded. A satisfaction survey was conducted among the PC physicians.

RESULTS

The one-year pilot study and the first year of implementation of the programme were evaluated. A total of 355 patients were included (median age 56.4 years; IQR 45.5-64.3); 61.2% (56.1-66.3%) were women. The waiting time for examination was 1.5 weeks (IQR 1.5-2.5). Gastroscopy was correctly indicated in 82.7% (78.4-86.3%) of patients. The median number of requests per month was 1.1 per 10,000 adults (range 0.8-1.6). Monthly referrals to SC clinics from the pilot centre fell by 11 subjects (95% CI 5.9-16) with respect to the previous median of 58 (IQR 48-64.5). Almost all those polled (98.4%) considered the programme useful in routine practice.

CONCLUSIONS

The availability of an early gastroscopy programme in PC for patients with dyspepsia and warning signs reduced the number of referrals to SC.

摘要

引言

消化不良在初级保健（PC）和专科护理（SC）中都是常见病症。如果存在警示症状，建议在研究开始时进行胃镜检查，尽管在初级保健中并非总能进行。

目的和方法

我们开展了一个试点项目，为初级保健中患有消化不良且有警示症状的患者建立早期胃镜检查计划，随后将其扩展至整个医疗区域。目的是评估该服务在初级保健层面的需求、影响和意见。记录了从试点中心转诊至专科护理的患者的人口统计学、症状和内镜检查变量。对初级保健医生进行了满意度调查。

结果

对为期一年的试点研究以及该计划实施的第一年进行了评估。共纳入355例患者（中位年龄56.4岁；四分位间距45.5 - 64.3）；61.2%（56.1 - 66.3%）为女性。检查等待时间为1.5周（四分位间距1.5 - 2.5）。82.7%（78.4 - 86.3%）的患者胃镜检查指征明确。每月每10000名成年人的请求中位数为1.1次（范围0.8 - 1.6）。与之前58例（四分位间距48 - 64.5）的中位数相比，试点中心每月转诊至专科护理诊所的人数减少了11例（95%置信区间5.9 - 16）。几乎所有受访者（98.4%）认为该计划在日常实践中有用。