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Overuse and underuse of diagnostic upper gastrointestinal endoscopy in various clinical settings

Seematter-Bagnoud, L. ; Vader, J-P ; Wietlisbach, V. ; Froehlich, F. ; Gonvers, J-J ; Burnand, B.

In: International Journal for Quality in Health Care, 1999, vol. 11, no. 4, p. 301-308

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    Title
    • Overuse and underuse of diagnostic upper gastrointestinal endoscopy in various clinical settings
    Author
    • Seematter-Bagnoud, L.. Institute of Social and Preventive Medicine, University of Lausanne, Switzerland
    • Vader, J-P. Institute of Social and Preventive Medicine, University of Lausanne, Switzerland
    • Wietlisbach, V.. Institute of Social and Preventive Medicine, University of Lausanne, Switzerland
    • Froehlich, F.. Division of Gastroenterology, Medical Outpatients Department, University of Lausanne, Switzerland
    • Gonvers, J-J. Division of Gastroenterology, Medical Outpatients Department, University of Lausanne, Switzerland
    • Burnand, B.. Institute of Social and Preventive Medicine, University of Lausanne, Switzerland
    Document Type
    • Postprint
    Language
    • English
    Published in
    • International Journal for Quality in Health Care, 1999, vol. 11, no. 4, p. 301-308. Oxford University Press
    Other Version
    OAI-PMH Identifier
    • oai:doc.rero.ch:304424
    Summary
    Objectives:To describe and compare both overuse and underuse of diagnostic upper gastrointestinal endoscopy in different settings. Design.Merging of data from three prospective observational studies. The appropriateness and necessity of indications for gastroscopy were evaluated using explicit criteria developed by a standardized expert panel method (RAND-UCLA). Inappropriate endoscopies represent overuse. Necessary indications not referred for the procedure constitute underuse. Setting.Three primary core outpatient clinics, 20 general practices, three gastroenterology practices, two district and one hospitals. Subjects.A third of the collective were consecutive ambulatory patients with upper abdominal complaints, whereas the other two-thirds were ambulatory and hospitalized patients referred for the procedure. Main outcome measures.Proportions of overuse and underuse in the different settings. Results. A total of 2885 patients were included (mean age, 49 years, 52% male, 2442 outpatients) 1858 outpatients underwent ⩾ 1 endoscopy. Among 2086 endoscopies, 805 (39%) were inappropriate, most of which were performed dyspepsia(83%). Overuse was higher in young , foreign, female patients and lower in inpatient settings, thee latter reflecting a different distribution of presenting symptoms. Among 1646 patient visits in primary care, overuse represented 148 endoscopies (9%). Underuse was identified in 104 of the same patient visits (6%) and was higher as patient age increased; There were no significant differences between men and women. Conclusions.Rates of overuse and underuse depend mainly on case presentation and patient characteristics. Both over- and underuse should be addressed to maintain and improve quality of care