• 作者：André ; s Dacal Rivas^a ; Paola Quintas Lorenzo^a ; Marí ; a Francisco Gonzá ; lez^a ; Joaquí ; n Cubiella Ferná ; ndez^a ; ^{joaquin.cubiella.fernandez@sergas.es} ; Marí ; a Nieves Alonso Docampo^b ; Javier Ferná ; ndez Seara^a
• 关键词：Atenció ; n primaria ; Guí ; a de prá ; ctica clí ; nica ; Implementació ; n de plan de salud ; Endoscopia gastrointestinal
• 刊名：Gastroenterolog铆a y Hepatolog铆a
• 出版年：2011
• 期刊代码：pca167_02105705
• 类别：med
• 出版时间：April 2011
• 卷：34
• 期：4
• 页码：254-261
• 文件大小：190 K

Introduction

Within a program to improve referrals by primary care (PC) in Ourense (Spain), we implemented practice guidelines on dyspepsia and rectal bleeding. Our aim was to evaluate the reasons for referral to endoscopy, the appropriateness of these referrals, and wait times.

Material and methods

We performed a retrospective cohort study in the Ourense health area between February 2009 and January 2010. The endoscopies performed with the indications of dyspepsia and rectal bleeding requested directly from PC were compared with those referred initially to specialist care (SC). The reasons for the referral, the priority of the endoscopy, compliance with the protocol, endoscopic finding and the wait time from referral were gathered.

Results

During the period analyzed, 158 upper gastrointestinal endoscopies (SC: 121; PC: 37) and 243 colonoscopies (SC: 193; PC: 50) were performed with the indications of dyspepsia and rectal bleeding. Among endoscopies, 34.5%and 77.7%were requested with high priority from PC and SC, respectively (p < 0.001). The criteria for referral were met in 86.5%of upper gastrointestinal endoscopies and in 82%of colonoscopies requested from PC. No differences were found in endoscopic findings. The median wait time from referral was lower in upper gastrointestinal endoscopy (PC: 105 卤 5.5 days, SC: 174 卤 17.8 days; p: 0.003) and colonoscopies (PC: 101 卤 11.8 days, SC: 187 卤 9.6 days; p < 0.001) referred from PC.

Conclusions

The use of the program for improved referrals by PC reduces wait times. The examinations requested complied with the indications.