ABSTRACT
BACKGROUND: In a context of increasing demand and pressure on the public health expenditure, appropriateness of colonoscopy indications is a topic of discussion. The objective of this study is to evaluate the appropriateness of colonoscopy requests performed in a primary care (PC) setting in Catalonia. METHODS: Cross-sectional descriptive study. Out-patients >14 years of age, referred by their reference physicians from PC or hospital care settings to the endoscopy units in their reference hospitals, to undergo a colonoscopy. Evaluation of the appropriateness of 1440 colonoscopy requests issued from January to July 2011, according to the EPAGE-II guidelines (European Panel on the Appropriateness of Gastrointestinal Endoscopy). RESULTS: The most frequent indications of diagnostic suspicion requests were: rectal bleeding (37.46 %), abdominal pain (26.54 %), and anaemia study (16.78 %). The most frequent indications of disease follow-up were adenomas (58.1 %), and CRC (31.16 %). Colonoscopy was appropriate in 73.68 % of the cases, uncertain in 16.57 %, and inappropriate in 9.74 %. In multivariate analysis, performed colonoscopies reached an OR of 9.9 (CI 95 % 1.16-84.08) for qualifying as appropriate for colorectal cancer (CRC) diagnosis, 1.49 (CI 95 % 1.1-2.02) when requested by a general practitioner, and 1.09 (CI 95 % 1.07-1.1) when performed on women. CONCLUSIONS: Appropriateness of colonoscopy requests in our setting shows a suitable situation in accordance with recognized standards. General practitioners contribute positively to this appropriateness level. It is necessary to provide physicians with simple and updated guidelines, which stress recommendations for avoiding colonoscopy requests in the most prevalent conditions in PC.
Subject(s)
Colonoscopy/statistics & numerical data , Unnecessary Procedures/statistics & numerical data , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Practice Guidelines as Topic , Referral and Consultation/statistics & numerical data , SpainSubject(s)
Humans , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/pathology , Mass Screening/ethics , Mass Screening/legislation & jurisprudence , Colorectal Neoplasms/etiology , Colorectal Neoplasms/genetics , Colorectal Neoplasms/therapy , Colorectal Neoplasms/prevention & control , Guaiac , Guaiac/standards , Mass Screening/methods , Mass Screening/statistics & numerical dataSubject(s)
Reimbursement Mechanisms/standards , Community Medicine , Family Practice , Humans , Societies, Medical , SpainABSTRACT
No disponible
No disponible
Subject(s)
Humans , Male , Female , Neoplasms/prevention & control , Ovarian Neoplasms/prevention & control , Uterine Cervical Neoplasms/prevention & control , Breast Neoplasms/prevention & control , Colorectal Neoplasms/prevention & control , Lung Neoplasms/prevention & controlABSTRACT
No disponible
Subject(s)
Evidence-Based Medicine/classification , Practice Guidelines as Topic/standardsABSTRACT
Los usuarios de guías de práctica clínica y otras recomendaciones necesitan saber hasta qué punto pueden confiar en ellas. Los juicios llevados a cabo mediante una metodología sistemática y explícita permiten disminuir los errores y mejorar la comunicación. Hemos desarrollado un sistema para clasificar la calidad de las evidencias y la fuerza de las recomendaciones pueda aplicarse a una amplia gama de intervenciones y contextos. En este artículo se presenta un resumen de nuestro enfoque desde la perspectiva del usuario de una guía. Los juicios sobre la fuerza de una recomendación deben tener en cuenta el balance entre beneficios y riesgos, la calidad de la evidencia, la aplicación de esta evidencia en circunstancias específicas y la situación de riesgo basal. Antes de elaborar una recomendación también es importante considerar los costes (utilización de recursos). La inconsistencia entre los sistemas que clasifican la calidad de la evidencia y la fuerza de las recomendaciones dificultan la evaluación crítica y la comunicación de estos juicios. Nuestro sistema, para llevar a cabo estos complejos juicios, equilibra la sencillez con la valoración global y transparente de todos los aspectos importantes
Subject(s)
Evidence-Based Medicine/classification , Practice Guidelines as Topic/standardsSubject(s)
Menopause , Postmenopause , Practice Guidelines as Topic , Aged , Female , Fractures, Bone/prevention & control , Humans , Menopause/drug effects , Middle Aged , Osteoporosis, Postmenopausal/complications , Osteoporosis, Postmenopausal/prevention & control , Primary Health Care , Spain , Sulpiride/analogs & derivatives , Sulpiride/pharmacologySubject(s)
Uterine Cervical Neoplasms/prevention & control , Adolescent , Adult , Aged , Female , Global Health , Humans , Mass Screening/standards , Middle Aged , Papillomavirus Infections , Practice Guidelines as Topic , Risk Factors , Spain/epidemiology , Uterine Cervical Neoplasms/epidemiology , Vaginal Smears/standardsABSTRACT
No disponible
Subject(s)
Female , Adult , Aged , Adolescent , Middle Aged , Humans , Uterine Cervical Neoplasms/prevention & control , Mass Screening/standards , Papillomavirus Infections , Practice Guidelines as Topic , Risk Factors , Vaginal Smears/standards , Global Health , Uterine Cervical Neoplasms/epidemiologyABSTRACT
No disponible
No disponible
Subject(s)
Female , Aged , Middle Aged , Humans , Menopause , Postmenopause , Practice Guidelines as Topic , Osteoporosis, Postmenopausal/complications , Osteoporosis, Postmenopausal/prevention & control , Primary Health Care , Spain , Sulpiride/analogs & derivatives , Sulpiride/pharmacology , Fractures, Bone/prevention & controlABSTRACT
No disponible
Subject(s)
Female , Aged , Middle Aged , Humans , Menopause , Osteoporosis, Postmenopausal/drug therapy , Osteoporosis, Postmenopausal/prevention & control , Postmenopause , Hot Flashes , Vagina/abnormalities , Hormones , Antidepressive Agents , Practice Guidelines as Topic , Primary Health CareABSTRACT
No disponible
Subject(s)
Female , Aged , Humans , Menopause , Postmenopause , Osteoporosis, Postmenopausal , Practice Guidelines as Topic , Primary Health Care , Fractures, Bone , Bone Density , Fractures, Bone/prevention & controlABSTRACT
No disponible
Subject(s)
Female , Aged , Humans , Menopause , Primary Health Care , Practice Guidelines as Topic , Hormone Replacement Therapy , Cerebrovascular Disorders , Coronary Disease , Thromboembolism , Dementia , Gallbladder/abnormalities , Breast Neoplasms , Endometrial Neoplasms , Ovarian NeoplasmsABSTRACT
No disponible