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Med J Aust. 2002 Feb 18;176(4):155-7.

Applying evidence-based guidelines improves use of colonoscopy resources in patients with a moderate risk of colorectal neoplasia.

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  • 1Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, SA. peter.bampton@flinders.edu.au

Abstract

OBJECTIVES:

To determine whether applying National Health and Medical Research Council (NHMRC) guidelines for colorectal cancer prevention would reduce the number of follow-up colonoscopies.

DESIGN:

A prospective audit of colonoscopic surveillance decisions before and after the intervention.

SETTING:

The endoscopy suite at a metropolitan tertiary hospital three months before and after January 2000.

INTERVENTION:

Dissemination of NHMRC guidelines, and supervision of application of the guidelines by a nurse coordinator.

SUBJECTS:

We compared colonoscopic surveillance decisions before and after the intervention in two groups of 100 consecutive patients after polypectomy and in two groups of 50 consecutive patients with a family history of colorectal cancer after a normal colonoscopy.

MAIN OUTCOME MEASURES:

Change in concordance of decisions with NHMRC guidelines; and effect on number of follow-up colonoscopies.

RESULTS:

After the intervention, the proportion of postpolypectomy surveillance decisions matching the guidelines increased from 37% to 96% (P < 0.05). The mean time to repeat colonoscopy after polypectomy increased from 2.7 to 3.5 years (P < 0.005) (ie, a 23% reduction in the number of postpolypectomy surveillance colonoscopies performed per year). Likewise, the proportion of family-history surveillance decisions matching the guidelines increased from 63% to 96%. Adhering to the guidelines resulted in a 17% reduction in colonoscopies performed on the basis of a family history of colorectal cancer.

CONCLUSIONS:

Supervised application of evidence-based guidelines to a colorectal cancer surveillance program significantly reduces the number of surveillance colonoscopies performed.

Comment in

PMID:
11913914
[PubMed - indexed for MEDLINE]
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