Priority and appropriateness of upper endoscopy out-patient referrals: Two-period comparison in an open-access unit. Issue 11 (November 2019)

• Record Type: Journal Article
• Authors: Meggio, Alberto; Mariotti, Giuliano; Gentilini, Maria; de Pretis, Giovanni
• Is Part Of: Digestive and liver disease. Volume 51:Issue 11(2019)
• Page Start: 1562
• Page End: 1566
• Publication Date: 2019-11
• Subjects: Appropriateness -- Waiting time -- Primary-secondary care interface; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2019.05.028
• Languages: English
• ISSNs: 1590-8658

Abstract

Abstract: Background: In the early 2000s we introduced a prioritization model for referrals based on involvement of primary care physicians (PCPs) and specialists. Aims: Assess the application of that model of prioritisation, comparing gastroscopies performed 8 years apart, with respect to priority level, appropriateness and relevant endoscopic findings (REFs). Methods: The studies included 247 and 354 out-patients, who had undergone gastroscopy in 2006 and in 2014, respectively. To reduce interspecialists variability, both studies were performed by the same specialist as investigator. Results: In both years, most patients were assigned low-priority referral by PCPs (78.6% and 75.1% respectively). The agreement PCPs versus specialist on referral priority was moderate in 2006 (0.60, Landis–Koch scale 0.41–0.60) and high in 2014 (0.81, Landis–Koch scale 0.81–1.00). In both years we observed a similar rate of inappropriateness: 27.5% and 27.1%, respectively. Due to multiple logistic regression, the odds ratio (OR) for REF increased when: (i) very high-priority referral versus nopriority referral was indicated (8.813 OR, p = 0.0012), (ii) referral followed the guidelines (9.29 OR, p<0.0001), and (iii) agreement of priority occurred (1.911 OR, p = 0.0308). Conclusions: Our findings highlighted that the issues of low-priority referrals should be addressed in order to discontinue gastroscopy overusing and reduce related operational costs.