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Applying evidence‐based guidelines improves use of colonoscopy resources in patients with a moderate risk of colorectal neoplasia
Author(s) -
Bampton Peter A,
Sandford Jayne J,
Young Graeme P
Publication year - 2002
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2002.tb04344.x
Subject(s) - colonoscopy , medicine , colorectal cancer , oncology , general surgery , intensive care medicine , cancer
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.