[The appropriateness of the indications and diagnostic efficiency of colonoscopy. Results of a survey conducted in all the hospital centers of the Provence-Alpes-Côte d'Azur area].
OBJECTIVE
To evaluate the appropriateness of indications and the diagnostic efficiency of colonoscopy taking into account available guidelines.


METHODS
This was a retrospective study conducted by the Union Régionale des Caisses d'Assurance Maladie de Provence-Alpes-Côte d'Azur (URCAM-Paca) aimed at assessing the appropriateness of the indications and diagnostic efficiency of colonoscopy. Anonymous data concerning near totality of the colonoscopies carried out during one week in all the establishments (public and private) of the area, were collected by consulting the medical records.


RESULTS
The indications for colonoscopy were first analyzed with regard to the guidelines for good clinical practices (références médicales opposables and consensus conference) according to two scales of reading (literal interpretation and broad interpretation). We noted that the available guidelines do not cover the totality of the colonoscopies performed, that their formulation does not make them all controllable, and that the colonoscopies, which respect them, range from 27.5% (strict reading) to 74.1% (broad reading). When taking into account not only the quality of the preparation, but also the result of the examination after re-classification into benign, pathological or normal examinations, the differences in efficiency appear only when one retains the broad interpretation of the reference guidelines. The efficiency analysis makes it possible to highlight a defect of predictability of the recommendations with regard to the pathologies considered as serious. It also appears that approximately 10% of the colonoscopies are, at the same time, out of the reference and have a normal result, and thus can be considered as absolutely not justified.


CONCLUSIONS
Better compliance of the practitioners to colonoscopy recommendations would initially be generated by improvement in the predictability and the legibility of the current reference guidelines.
Sauze
Laurent
L
Médecin-Conseil Régional, Caisse Maladie Régionale de Provence, 150 rue Paradis 13006 Marseille. laurent.sauze@cmr-provence.canam.fr
Berdeu
Daniel
D
Mabriez
Jean-Claude
JC
Jacqueme
Béatrice
B
Lapalus
David
D
Eisinger
François
F
Moatti
Jean-Paul
JP
D003113:Colonoscopy / Q000592:standards*; D003627:Data Interpretation, Statistical; D005260:Female; D005602:France; D019983:Guideline Adherence; D006761:Hospitals; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008499:Medical Records; D017410:Practice Guidelines as Topic; D012016:Reference Values; D012189:Retrospective Studies