Aims Overuse of colonoscopy (CS) is an increasingly recognized problem.
However there are few publications describing tools to reduce the realization of CSs non-adherents with the clinical guidelines.
Objectives
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Detect CSs referral from Primary Care (CS-PC) received in our Unit that do not meet criteria of European and Spanish Guidelines.
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Definitely deny non-adherents request forms or temporarily those with insufficient data.
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Detect CSs requests in individuals with alarm symptoms
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Deny those for symptoms already studied in < 50 years old patients and CS < 3 years earlier (SS).
Estimate the repercussion of this intervention on waiting times
Methods We met with PC doctors and inserted guidelines into the intranet.
Systematic evaluation of CS-PC requests received (March 2011-December 2018). We complete data with the Electronic Clinical Record (ECR). We collected affiliation, priority, indication, FH-CRC, previous CSs.
The denied CSs were collected in the ECR and were mailed to the doctor, explaining the reason for the refusal. A contact email was provided for contact us.
Accepted requests were classified into: Preferent (P), Conventional(C) and Surveillance (S).
Patient´s written reclaims were collected.
Results 9,158 requests: 7,327 (80%) accepted (9.9% P, 38.1% C, 52% S) and 1,831 (20%) denied (1,291 definitely -14.1% of all request- and 540 temporarily).
Cause of deny: 50.1% FH-CRC, 45.4% PPS and 4.5% SS.
Rate of rejected decreased from 18.5% (2011) to 8.6% (2018).
Written claims decreased from 25% (2011) to16% (2018).
Prior to the intervention, average months delay for all CSs: 6 and after: 3 for C, 10 for S and 0.5 for P.
Conclusions 1- Review of CS-PC avoid a14.1% unnecessary CSs, mainly by FH-CRC and PPS
2- Makes sense on the waiting list, prioritizing the CSs with alarm data although surveillance ones wait more
3- Physicians and patients´ acceptance is good as long as a fluid communication is manteined.
