Zuccaro G, Provencher K
Department of Gastroenterology, Cleveland Clinic Foundation, Ohio 44195, USA.
Gastrointest Endosc. 1997 Jul;46(1):15-20. doi: 10.1016/s0016-5107(97)70203-7.
In an effort to maintain procedure volumes and control consultation costs, many gastrointestinal endoscopists and primary care providers have implemented systems of open access endoscopy. In these systems, specialists in digestive diseases perform endoscopy without prior consultation. The purpose of this study is to determine if indications for upper endoscopic procedures requested in an open access system conform to national practice guidelines and to establish the yield of diagnostic information relevant for patient care in this system.
Procedural indications and results for 3715 upper endoscopic procedures performed in an open access system were recorded in a computer database. The practice guideline "Appropriate Use of Gastrointestinal Endoscopy" (AUGE) of the American Society for Gastrointestinal Endoscopy was used to determine appropriateness of procedural indications.
Eighty-four percent of procedures were performed for indications listed in the AUGE, and 59% resulted in findings relevant to patient care. Specialists requested endoscopy more frequently for "approved" indications than did nonspecialists (p = .004) and more frequently had findings relevant to patient care (p < .001). Findings relevant to patient care are significantly more frequent for some indications listed in the AUGE compared to others (p < .001).
Adherence to practice guidelines can and does occur in an open access system. Specialists request endoscopy more frequently for appropriate indications compared to nonspecialists and have a higher yield of information relevant to patient care. Further refinement and better definition of some indications within the AUGE are needed to increase the clinical utility of this document.
为了维持手术量并控制会诊成本，许多胃肠内镜医师和初级保健提供者已经实施了开放获取式内镜检查系统。在这些系统中，消化系统疾病专家无需事先会诊即可进行内镜检查。本研究的目的是确定开放获取系统中所要求的上消化道内镜检查手术指征是否符合国家实践指南，并确定该系统中与患者护理相关的诊断信息的产出率。
在一个计算机数据库中记录了在开放获取系统中进行的3715例上消化道内镜检查手术的手术指征和结果。采用美国胃肠内镜学会的实践指南《胃肠内镜的合理使用》（AUGE）来确定手术指征的适宜性。
84%的手术是针对AUGE中列出的指征进行的，59%的手术结果与患者护理相关。与非专科医生相比，专科医生更频繁地因“批准的”指征要求进行内镜检查（p = 0.004），并且更频繁地有与患者护理相关的检查结果（p < 0.001）。与AUGE中列出的其他一些指征相比，某些指征与患者护理相关的检查结果明显更频繁（p < 0.001）。
在开放获取系统中可以并且确实会遵循实践指南。与非专科医生相比，专科医生更频繁地因适当的指征要求进行内镜检查，并且与患者护理相关的信息产出率更高。需要对AUGE中的一些指征进行进一步细化和更好的定义，以提高该文件的临床实用性。
