Open Access Colonoscopy for Colorectal Cancer Prevention: An Evaluation of Appropriateness and Quality

Kapila, Nikhil; Singh, Harjinder; Kandragunta, Kiranmayee; Castro, Fernando

doi:10.1007/s10620-019-05612-8

Cited by 9 publications

(14 citation statements)

References 25 publications

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“…Interestingly enough, roughly 75% of these inappropriately scheduled colonoscopies were non-adherent to the above guidelines, whereas the remaining 25% was due to inappropriate use of family history by the primary care physician (PCP). Thus, the study confirms that: a) PCPs recommend repeat colonoscopy sooner than guidelines suggest [15,16]; and b) a significant proportion of open access colonoscopies for colorectal cancer prevention are indeed inappropriate, confirming the figure of nearly 8% according to a recent review by Kapila et al [17]. Thus, the question arises of how to improve the use of OA colonoscopy for CRC screening and surveillance, since this might reduce the volume of procedures without delaying CRC detection.…”

supporting

confidence: 74%

Guidelines for the Perplexed: How to Maximize Colonoscopy Efficiency During the COVID-19 Pandemic

Grossi¹,

Pace²

2020

Dig Dis Sci

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supporting

confidence: 74%

Guidelines for the Perplexed: How to Maximize Colonoscopy Efficiency During the COVID-19 Pandemic

Grossi¹,

Pace²

2020

Dig Dis Sci

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“…During this time, it is important to highlight that OA procedures may be desirable because they increase screening while eliminating unnecessary office visits and associated costs. 1,2,6,8 OA patients do not require a GI consult, which decreases waiting time before scheduled colonoscopies and expedites screening and diagnostic procedures for patients with uncomplicated past medical histories. 9 This may also help decrease delays in diagnosing GI diseases.…”

Section: Discussionmentioning

confidence: 99%

“…9 While OA has the potential to decrease costs by eliminating unnecessary office visits, OA providers order inappropriate colonoscopies more often and, in some cases, are more prone to medical omission errors. 1,[26][27][28][29] Lack of specific experience may contribute to inappropriate referrals. These errors can lead to unnecessary exposure to the risks associated with colonoscopy, such as perforation, bleeding requiring transfusion, or serious complications like myocardial infarction (MI).…”

Section: Discussionmentioning

confidence: 99%

“…Open access (OA) colonoscopies are defined as those requested by a referring physician without gastroenterologist consultation or an office visit. 1 Over the past decade, OA procedures have become more prevalent. A study conducted by Ghaoui et al found that only one-fifth (178/1000) of colonoscopies done in the United States are done by OA, despite it offering many advantages.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, studies have shown that OA procedures decrease patient costs related to possible unnecessary office consultations. 1,2,6,8 Despite the benefits that an OA colonoscopy presents, its use has not been fully adopted. 2 The major concern from the provider's perspective is the uncertainty of achieving a high-quality colonoscopy.…”

Section: Introductionmentioning

confidence: 99%

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Open‐access colonoscopy quality indicators and patient perception using split‐dose bowel preparation

et al. 2021

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Background and Aim: Open-access (OA) colonoscopies are defined as those scheduled without a gastrointestinal (GI) office visit. Past research has not focused on split preparation use and patient perception within OA. We aim to identify differences in bowel preparation (BP) adequacy, adenoma detection rate (ADR), self-reported compliance, and patient perception between OA and GI providers using split prep. Methods: This was a cross-sectional study using split BP for colonoscopies. Patients completed a survey, and demographics, BP adequacy, and ADR were recorded. BP compliance was self-reported. Patients were asked three questions qualifying the BP instructions. Data were analyzed using chi square and Mann-Whitney tests by SPSS. Results: BP adequacy was reported for 56 of 60 patients. Twenty-one participants (38%) were scheduled on OA, and 35 participants (62%) were scheduled after a GI office visit. Adequate BP was more frequent in 86% (18/21) of OA patients compared to 60% (21/35) in the GI group (P = 0.043). OA patients reported better review and explanation of the BP instructions compared to GI patients. There was no statistical difference between the demographics of the OA and GI groups or self-reported compliance and patient understanding of instructions. Conclusion: OA scheduled colonoscopies were associated with more adequate BP. This could be explained by patients' self-motivation or an explanation of the importance of completing BP. This study supports the use of OA procedures as a standard of care.

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Clinical care pathway program versus open-access system: a study on appropriateness, quality, and efficiency in the delivery of colonoscopy in the colorectal cancer

et al. 2021

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Open-access colonoscopy (OAC), whereby the colonoscopy is performed without a prior office visit with a gastroenterologist, is affected by inappropriateness which leads to overprescription and reduced availability of the procedure in case of alarming symptoms. The clinical care pathway (CCP) is a healthcare management tool promoted by national health systems to organize work-up of various morbidities. Recently, we started a CCP dedicated to colorectal cancer (CRC), including a colonoscopy session for CRC diagnosis and prevention. We aimed to evaluate the appropriateness, the quality, and the efficiency in the delivery of colonoscopy with the open-access system and a CCP program in the CRC. Quality indicators for colonoscopy in subjects in the CCP were compared to referrals by general practitioners (OAC) or by non-gastroenterologist physicians (non-gastroenterologist physician colonoscopy, NGPC). Attendance rate to colonoscopy was greater in the CCP group and NGPC group than in the OAC group (99%, 99%, and 86%, respectively). Waiting time in the CCP group was shorter than in the OAC group (3.88 ± 2.27 vs. 32 ± 22.31 weeks, respectively). Appropriateness of colonoscopy prescription was better in the CCP group than in the OAC group (92 vs. 50%, respectively). OAC is affected by the lack of timeliness and low appropriateness of prescription. A CCP reduces the number of inappropriate colonoscopies, especially for post-polypectomy surveillance, and improves the delivery of colonoscopy in patients requiring a fast-track examination. The high rate of inappropriate OAC suggests that this modality of healthcare should be widely reviewed.

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Open Access Colonoscopy for Colorectal Cancer Prevention: An Evaluation of Appropriateness and Quality

Cited by 9 publications

References 25 publications

Guidelines for the Perplexed: How to Maximize Colonoscopy Efficiency During the COVID-19 Pandemic

Guidelines for the Perplexed: How to Maximize Colonoscopy Efficiency During the COVID-19 Pandemic

Open‐access colonoscopy quality indicators and patient perception using split‐dose bowel preparation

Clinical care pathway program versus open-access system: a study on appropriateness, quality, and efficiency in the delivery of colonoscopy in the colorectal cancer

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