Department of Systems Medicine, Gastroenterology Unit, University of Rome "Tor Vergata", Rome, Italy.
Department of Internal Medicine, University of Mutah, Karak, Jordan.
Intern Emerg Med. 2021 Aug;16(5):1197-1206. doi: 10.1007/s11739-020-02565-z. Epub 2021 Feb 8.
Open-access colonoscopy (OAC), whereby the colonoscopy is performed without a prior office visit with a gastroenterologist, is affected by inappropriateness which leads to overprescription and reduced availability of the procedure in case of alarming symptoms. The clinical care pathway (CCP) is a healthcare management tool promoted by national health systems to organize work-up of various morbidities. Recently, we started a CCP dedicated to colorectal cancer (CRC), including a colonoscopy session for CRC diagnosis and prevention. We aimed to evaluate the appropriateness, the quality, and the efficiency in the delivery of colonoscopy with the open-access system and a CCP program in the CRC. Quality indicators for colonoscopy in subjects in the CCP were compared to referrals by general practitioners (OAC) or by non-gastroenterologist physicians (non-gastroenterologist physician colonoscopy, NGPC). Attendance rate to colonoscopy was greater in the CCP group and NGPC group than in the OAC group (99%, 99%, and 86%, respectively). Waiting time in the CCP group was shorter than in the OAC group (3.88 ± 2.27 vs. 32 ± 22.31 weeks, respectively). Appropriateness of colonoscopy prescription was better in the CCP group than in the OAC group (92 vs. 50%, respectively). OAC is affected by the lack of timeliness and low appropriateness of prescription. A CCP reduces the number of inappropriate colonoscopies, especially for post-polypectomy surveillance, and improves the delivery of colonoscopy in patients requiring a fast-track examination. The high rate of inappropriate OAC suggests that this modality of healthcare should be widely reviewed.
标题：基于临床护理路径的开放预约结肠镜检查（OAC）对结直肠癌患者的影响
摘要：开放预约结肠镜检查（OAC）指的是在没有预先就诊于胃肠病学家的情况下进行结肠镜检查，这种模式可能会导致不适当的检查，从而导致过度处方和在出现警报症状时减少该程序的可用性。临床护理路径（CCP）是一种由国家卫生系统推广的医疗管理工具，用于组织各种疾病的工作流程。最近，我们启动了一个专门针对结直肠癌（CRC）的 CCP，包括一个用于 CRC 诊断和预防的结肠镜检查环节。我们旨在评估开放预约系统和 CRC 中 CCP 计划下结肠镜检查的适宜性、质量和效率。将 CCP 中的结肠镜检查质量指标与全科医生（OAC）或非胃肠病学家医生（非胃肠病学家结肠镜检查，NGPC）转诊进行比较。参加结肠镜检查的人数在 CCP 组和 NGPC 组中高于 OAC 组（分别为 99%、99%和 86%）。CCP 组的等待时间短于 OAC 组（分别为 3.88±2.27 周和 32±22.31 周）。CCP 组的结肠镜检查处方适宜性优于 OAC 组（分别为 92%和 50%）。OAC 受到及时性和处方适宜性低的影响。CCP 减少了不适当的结肠镜检查数量，尤其是在息肉切除术后的监测方面，并改善了需要快速通道检查的患者的结肠镜检查的实施。高比例的不适当 OAC 表明应广泛审查这种医疗保健模式。
