Mahajan R J, Barthel J S, Marshall J B
Division of Gastroenterology, University of Missouri Hospital and Clinics, Columbia, USA.
Arch Intern Med. 1996 Oct 14;156(18):2065-9.
Open-access endoscopy allows nongastroenterologist physicians the opportunity to directly schedule elective common endoscopic procedures for their patients without having them first examined in the gastrointestinal clinic. There are few data as to whether nongastroenterologist physicians in the United States schedule patients for appropriate indications.
To examine our practice to see whether patients undergoing open-access endoscopy were scheduled for appropriate indications and to see whether there were differences among physicians in various medical specialties.
We prospectively tracked 310 consecutive patients scheduled for open-access esophagogastroduodenoscopy (EGD) and colonoscopy by nongastroenterologist physicians over a 9-month period in our academic practice setting to determine whether the indications for performing the procedures were appropriate. The American Society for Gastrointestinal Endoscopy criteria (revised in 1992) were used as the standard for comparison.
Primary care physicians (family practitioners and general internists) did a superior job of scheduling patients for appropriate indications for EGD and colonoscopy than did non-primary care physicians (internal medicine subspecialists and surgeons): 97.0% vs 81.3% for EGD (P = .04) and 84.9% vs 66.7% for colonoscopy (P = .02), respectively.,
Primary care physicians were significantly more likely to schedule patients for open-access EGD and colonoscopy for appropriate indications than were non-primary care physicians. The frequency of inappropriate indications for colonoscopy referrals was greater than for EGD. The reasons for the differences among primary care physicians, surgeons, and internal medicine subspecialists require further exploration.
开放式内镜检查使非胃肠病学医生有机会直接为其患者安排选择性常见内镜检查程序，而无需患者先在胃肠病诊所接受检查。关于美国非胃肠病学医生为患者安排检查的适应证是否恰当，相关数据较少。
检查我们的做法，以确定接受开放式内镜检查的患者是否因恰当的适应证而被安排检查，并查看不同医学专科的医生之间是否存在差异。
在我们的学术实践环境中，我们前瞻性地跟踪了非胃肠病学医生在9个月内连续安排的310例接受开放式食管胃十二指肠镜检查（EGD）和结肠镜检查的患者，以确定进行这些检查的适应证是否恰当。采用美国胃肠内镜学会标准（1992年修订）作为比较标准。
在为EGD和结肠镜检查安排具有恰当适应证的患者方面，初级保健医生（家庭医生和普通内科医生）比非初级保健医生（内科专科医生和外科医生）做得更好：EGD分别为97.0%对81.3%（P = .04）；结肠镜检查分别为84.9%对66.7%（P = .02）。
与非初级保健医生相比，初级保健医生为患者安排开放式EGD和结肠镜检查以适应恰当适应证的可能性显著更高。结肠镜检查转诊适应证不恰当的频率高于EGD。初级保健医生、外科医生和内科专科医生之间存在差异的原因需要进一步探究。
