Froehlich F, Burnand B, Pache I, Vader J P, Fried M, Schneider C, Kosecoff J, Kolodny M, DuBois R W, Brook R H, Gonvers J J
Department of Gastroenterology, Medical Outpatient Department PMU/CHUV, Lausanne, Switzerland.
Gastrointest Endosc. 1997 Jan;45(1):13-9.
This prospective observational study was aimed at evaluating the appropriateness of use of upper gastrointestinal endoscopy (UGE) in primary care in a country with open access to and high availability of the procedure.
Outpatients were consecutively included in two clinical settings: Setting A (20 primary care physicians during 4 weeks) and B (university-based outpatient clinic during 3 weeks). In patients undergoing UGE, appropriateness of referral was judged by explicit Swiss criteria developed by the RAND/UCLA panel method.
Patient visits (8135) were assessed. Six hundred eleven patients complained of upper gastrointestinal symptoms. Physicians decided to perform UGE in 63 of these patients. Twenty-five (40%) of the endoscopies were rated appropriate, 7 (11%) equivocal, and 31 (49%) inappropriate. Overuse of UGE occurred in 5.1% (setting A: 4.7%; setting B:6.5%; p = 0.39) of the patients who presented with upper gastrointestinal symptoms. The decision to perform UGE in previously untreated dyspeptic patients was the most common clinical situation resulting in overuse.
Inappropriate use of UGE is high in Switzerland. However, to better reflect primary care decision making, overuse should be related not only to patients referred for a medical test, but also to the number of patients who complain of the symptoms that would be investigated by the procedure.
这项前瞻性观察性研究旨在评估在一个可自由获取且该检查手段高度普及的国家，基层医疗中使用上消化道内镜检查（UGE）的合理性。
门诊患者被连续纳入两种临床环境：环境A（4周内20名基层医疗医生）和环境B（大学门诊诊所3周）。对于接受UGE检查的患者，转诊的合理性依据兰德/加州大学洛杉矶分校小组法制定的明确瑞士标准进行判断。
共评估了8135次患者就诊情况。611名患者主诉有上消化道症状。医生决定对其中63名患者进行UGE检查。其中25例（40%）内镜检查被评为合理，7例（11%）不明确，31例（49%）不合理。在上消化道症状患者中，UGE检查过度使用发生率为5.1%（环境A：4.7%；环境B：6.5%；p = 0.39）。对既往未治疗的消化不良患者进行UGE检查的决定是导致过度使用的最常见临床情况。
在瑞士，UGE检查的不合理使用情况较为严重。然而，为了更好地反映基层医疗决策，过度使用不仅应与接受医学检查转诊的患者相关，还应与主诉有该检查手段所针对症状的患者数量相关。
