Recommendations and quality criteria to improve the early diagnosis of primary biliary cholangitis. / Recomendaciones y criterios de calidad para mejorar el diagnóstico precoz de la colangitis biliar primaria.

OBJECTIVE: The study aimed to establish recommendations and quality criteria to enhance the healthcare process of PBC. PATIENTS AND METHODS: It was conducted using qualitative techniques, preceded by a literature review. A consensus conference involving five specialists in the field was held, followed by a Delphi process developed in two waves, in which 30 specialist physicians in family and community medicine, digestive system and internal medicine were invited to participate. RESULTS: Seven recommendations and 15 sets of quality criteria, indicators and standards were obtained. Those with the highest consensus were «Know the impact on the patient's quality of life. Consider their point of view and agree on recommendations and care¼ and «Evaluate possible fibrosis at the time of diagnosis and during PBC follow-up, assessing the evolution of factors associated with poor disease prognosis: noninvasive fibrosis (elastography > 2.1 kPa/year), GGT, ALP and bilirubin annually¼, respectively. CONCLUSIONS: The implementation of the consensus recommendations and criteria would provide better patient care. The need for multidisciplinary follow-up and an increased role of primary care is emphasized.

Implantación y evaluación de una prestación de gastroscopia precoz para pacientes con dispepsia y datos de alarma en Atención Primaria / Implementation and evaluation of early gastroscopy for patients with dyspepsia and warning signs in Primary Care

INTRODUCCIÓN: La dispepsia es un trastorno frecuente tanto en Atención Primaria (AP) como Especializada (AE). Se recomienda realizar una gastroscopia al inicio del estudio si existen datos de alarma, aunque su accesibilidad desde AP es variable. Objetivos y métodos: Desarrollamos un proyecto piloto estableciendo una agenda de gastroscopia precoz para pacientes con dispepsia y datos de alarma en AP, ampliándolo posteriormente a toda el área sanitaria. El objetivo fue evaluar los requerimientos, el impacto y la valoración desde AP de esta prestación. Recogimos variables demográficas, sintomáticas y endoscópicas de los pacientes remitidos y las derivaciones a AE desde el centro piloto. Se realizó una encuesta de satisfacción entre los facultativos de AP. RESULTADOS: Se evaluaron el proyecto piloto, de un año de duración, y el primer año de implantación de la agenda, con un total de 355 pacientes (edad mediana 56,4 años; RIQ 45,5-64,3). El 61,2% (56,1-66,3%) eran mujeres. La demora hasta la exploración fue de 1,5 semanas (RIQ 1,5-2,5). El 82,7% (78,4-86,3%) de las gastroscopias fueron indicadas correctamente. La mediana mensual de solicitudes fue de 1,1 por cada 10.000 adultos (rango 0,8-1,6). Las derivaciones mensuales a consultas de AE desde el centro piloto disminuyeron en 11 sujetos (IC 95% 5,9-16), respecto a la mediana previa de 58 (RIQ 48-64,5). El 98,4% de los encuestados consideraron la agenda útil en su práctica habitual. CONCLUSIONES: La disponibilidad de una agenda de gastroscopia precoz en AP para pacientes con dispepsia y datos de alarma disminuye el número de derivaciones a AEM

INTRODUCTION: Dyspepsia is a common disorder in both Primary (PC) and Specialised Care (SC). Gastroscopy is recommended at the start of the study if there are warning signs, although it is not always available in PC. Objectives and methods: We developed a pilot project establishing an early gastroscopy programme for patients with dyspepsia and warning signs in PC, subsequently extending it to the entire healthcare area. The aim was to evaluate the requirements, impact and opinion of this service at the PC level. Demographic, symptomatic and endoscopic variables on the patients referred to SC from the pilot centre were recorded. A satisfaction survey was conducted among the PC physicians. RESULTS: The one-year pilot study and the first year of implementation of the programme were evaluated. A total of 355 patients were included (median age 56.4 years; IQR 45.5-64.3); 61.2% (56.1-66.3%) were women. The waiting time for examination was 1.5 weeks (IQR 1.5-2.5). Gastroscopy was correctly indicated in 82.7% (78.4-86.3%) of patients. The median number of requests per month was 1.1 per 10,000 adults (range 0.8-1.6). Monthly referrals to SC clinics from the pilot centre fell by 11 subjects (95% CI 5.9-16) with respect to the previous median of 58 (IQR 48-64.5). Almost all those polled (98.4%) considered the programme useful in routine practice. CONCLUSIONS: The availability of an early gastroscopy programme in PC for patients with dyspepsia and warning signs reduced the number of referrals to SC

Implementation and evaluation of early gastroscopy for patients with dyspepsia and warning signs in Primary Care. / Implantación y evaluación de una prestación de gastroscopia precoz para pacientes con dispepsia y datos de alarma en Atención Primaria.

INTRODUCTION: Dyspepsia is a common disorder in both Primary (PC) and Specialised Care (SC). Gastroscopy is recommended at the start of the study if there are warning signs, although it is not always available in PC. OBJECTIVES AND METHODS: We developed a pilot project establishing an early gastroscopy programme for patients with dyspepsia and warning signs in PC, subsequently extending it to the entire healthcare area. The aim was to evaluate the requirements, impact and opinion of this service at the PC level. Demographic, symptomatic and endoscopic variables on the patients referred to SC from the pilot centre were recorded. A satisfaction survey was conducted among the PC physicians. RESULTS: The one-year pilot study and the first year of implementation of the programme were evaluated. A total of 355 patients were included (median age 56.4 years; IQR 45.5-64.3); 61.2% (56.1-66.3%) were women. The waiting time for examination was 1.5 weeks (IQR 1.5-2.5). Gastroscopy was correctly indicated in 82.7% (78.4-86.3%) of patients. The median number of requests per month was 1.1 per 10,000 adults (range 0.8-1.6). Monthly referrals to SC clinics from the pilot centre fell by 11 subjects (95% CI 5.9-16) with respect to the previous median of 58 (IQR 48-64.5). Almost all those polled (98.4%) considered the programme useful in routine practice. CONCLUSIONS: The availability of an early gastroscopy programme in PC for patients with dyspepsia and warning signs reduced the number of referrals to SC.