The team from Lausanne, Switzerland, collaborated with scientists in Santa Monica and Los Angeles, California, US. In a prospective observational study they evaluated the appropriateness and necessity of referral for colonoscopy. Explicit criteria developed by a standardized expert panel method were used.
Inappropriate referrals constituted ‘overuse'. Patients with necessary colonoscopy indications who were not referred were considered to be ‘underuse'.
Patients from 22 general practices in Switzerland, a country with ready access to colonoscopy, were enrolled during a 4-week period. All displayed lower gastrointestinal (GI) symptoms. Follow-up data were obtained at 3 months for patients who did not undergo a necessary colonoscopy.
8760 patient visits were screened for inclusion. 7.4% of patients had lower GI symptoms (mean age 56.4 years, 68% women). Of these, 12% were referred for colonoscopy.
Indications for colonoscopy in 11 patients (14% of colonoscopy referrals or 1.7% of all patients with lower GI symptoms) were judged inappropriate.
Among 573 patients not referred for the procedure, underuse ranged between 11% and 28% of all patients with lower GI symptoms, depending on the criteria used.
Underuse in Swiss patients with lower GI symptoms: 11% to 28%
Dr John-Paul Vader concluded that "In Switzerland underuse of referral for colonoscopy exceeds overuse in primary care. To improve quality of care, both overuse and underuse of important procedures must be addressed.
"This is the first time that overuse and underuse of colonoscopy have been simultaneously evaluated in the same patient population."