Prescription of additional tests to perform colonoscopy under sedation
DOI:
https://doi.org/10.32385/rpmgf.v34i4.12483Keywords:
Colonoscopy, Diagnostic tests, Efficiency, Organisational.Abstract
In the current context of health resources, efficiency is a crucial goal. This matter is essential and one of the fundamental principles of general practice/family medicine. Objectives: To characterise the procedures related with the prescription of additional tests to perform colonoscopy with sedation, of the institutions under convention with the North Regional Health Administration. Methods: The institutions of Porto Ocidental Health Centre Group (ACeS) that provide colonoscopy under sedation to National Health Services (NHS) beneficiaries were contacted, in March 2016, by telephone. The questions focused on the additional exams required to perform colonoscopy under sedation, for how long the additional tests were valid, and on the differences on procedures according to age and presence of co-morbidities. Results: Twenty-two institutions were contacted, and 19 responses were obtained – response rate of 86%; 100% of the institutions request international normalized ratio (INR), 95% haemogram with platelet count; 58% kidney function; 53% glucose; 42% ionogram; and 100% EKG. There were no standard criteria regarding the prescription of EKG or other specific procedures related with the presence of co-morbidities. The period in which the additional tests were valid varied between three and six months. The total cost of additional tests varied between a minimum of € 10.38 and a maximum of € 41.66. Considering the number of colonoscopies performed in the year 2015 at ACeS Porto (3072), it is estimated that the cost of these tests can vary between € 31,887.36 and € 127,979.52, with an estimated difference in procedures of € 96,092.16. Discussion: Differences were observed in the type of care provided, in the clarity of the information shared, in the knowledge of the additional exams performed, and in the criteria for request of EKG. Conclusions: There is a clear need to develop a consensus document that will allow to reduce the variability of these procedures, avoid unnecessary procedures/expenses, ensuring safety and best practice regarding to these procedures.Downloads
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