Hungin A P, Thomas P R, Bramble M G, Corbett W A, Idle N, Contractor B R, Berridge D C, Cann G
Middlesbrough General Hospital.
Br J Gen Pract. 1994 Nov;44(388):519-21.
Open access gastroscopy allows general practitioners to request a gastroscopy without prior referral to a specialist. The effect of open access gastroscopy upon patient management is poorly explored. Most studies have been hospital based and have focused on diagnostic yields and on means of tightening requests to reduce inefficient use. A user evaluation can only be made by measuring outcomes in primary care.
A study was undertaken to determine the impact of open access gastroscopy in general practice and in particular, the value of a normal result.
All general practices in South Tees District Health Authority were asked to participate. Any of their patients who had had open access gastroscopy in the year prior to July 1990 were identified from the hospital computer and their general practitioner notes examined. Patient management during the year prior to the open access gastroscopy was compared with the year after. The main outcome measures were: detection rate and grade of lesion, change in graded score of prescribed drugs, consultation rate for dyspepsia and non-dyspepsia problems, and further hospital referral and investigations. Outcomes among those with normal and abnormal gastroscopy results were compared.
The study sample comprised 715 patients, 36% of whom had a normal gastroscopy result, 34% a major abnormality and 26% a minor abnormality (4% of patients had miscellaneous diagnoses). It was found that 39% of all patients, and 60% of those with normal findings on open access gastroscopy had their drug treatment stopped or reduced in grade after the investigation. Of those with a major endoscopic abnormality 58% increased their treatment score. Consultations for dyspepsia in the year before and after gastroscopy fell by 57% overall among those with a normal gastroscopy result, by 37% among those with a minor finding and by 33% in those with a major finding. There was a 21% fall in consultations for all reasons among those with a normal gastroscopy result but those with a minor abnormality had a 23% increase in non-dyspepsia consultations. Of all patients 19% were referred to hospital subsequently.
Open access gastroscopy has a major effect upon patient management in general practice, and a normal endoscopy result has an important an impact as an abnormal one. Open access gastroscopy is associated with a rationalization of drug therapy, reduced consultations and a low hospital referral rate.
开放式胃镜检查使全科医生无需事先转诊给专科医生即可申请胃镜检查。开放式胃镜检查对患者管理的影响鲜有研究。大多数研究以医院为基础，重点关注诊断率以及收紧检查申请以减少低效使用的方法。只有通过衡量初级保健中的结果才能进行用户评估。
开展一项研究以确定开放式胃镜检查在全科医疗中的影响，尤其是正常检查结果的价值。
邀请南蒂赛德区卫生局的所有全科医疗机构参与。从医院计算机中识别出1990年7月前一年中接受过开放式胃镜检查的患者，并检查其全科医生记录。将开放式胃镜检查前一年的患者管理情况与检查后一年进行比较。主要结局指标包括：病变的检出率和分级、处方药分级评分的变化、消化不良和非消化不良问题的会诊率，以及进一步的医院转诊和检查。比较了胃镜检查结果正常和异常患者的结局。
研究样本包括715名患者，其中36%的患者胃镜检查结果正常，34%有重大异常，26%有轻微异常（4%的患者有其他诊断）。研究发现，所有患者中有39%，开放式胃镜检查结果正常的患者中有60%在检查后停止用药或降低了药物治疗分级。在内镜检查有重大异常的患者中，58%提高了治疗评分。胃镜检查结果正常的患者中，胃镜检查前后一年消化不良会诊总体下降了57%，有轻微异常的患者下降了37%，有重大异常的患者下降了33%。胃镜检查结果正常的患者因各种原因的会诊下降了21%，但有轻微异常的患者非消化不良会诊增加了23%。所有患者中有19%随后被转诊至医院。
开放式胃镜检查对全科医疗中的患者管理有重大影响，正常的内镜检查结果与异常结果一样具有重要影响。开放式胃镜检查与药物治疗的合理化、会诊减少和低医院转诊率相关。
