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

摘要: Objectives. To describe and compare both overuse underuse of diagnostic upper gastrointestinal endoscopy in different settings. Design. Merging data from three prospective observational studies. The appropriateness necessity indications for gastroscopy were evaluated using explicit criteria developed by a standardized expert panel method (RAND-UCLA). Inappropriate endoscopies represent overuse. Necessary not referred the procedure constitute underuse. Setting. Three primary care outpatient clinics, 20 general practices, gastroenterology two district one university hospitals. Subjects. A third collective consecutive ambulatory patients with abdominal complaints, whereas other two-thirds hospitalized procedure. Main outcome measures. Proportions Results. total 2885 included (mean age, 49 years, 52% male, 2442 outpatients), 1858 underwent [ 1 endoscopy. Among 2086 endoscopies, 805 (39%) inappropriate, most which performed dyspepsia (83%). Overuse was higher young, foreign, female lower inpatient settings, latter reflecting distribution presenting symptoms. 1646 patient visits care, represented 148 (9%). Underuse identified 104 same (6%) as age increased; there no significant differences between men women. Conclusions. Rates depend mainly on case presentation characteristics. Both overand should be addressed to maintain improve quality care.