The appropriate management of symptomatic gastro-oesophageal reflux disease (GORD) in primary care: a systematic analysis of expert opinion.
OBJECTIVE
To explore the appropriate indications for endoscopy and short-term anti-secretory treatment in patients with symptoms of gastro-oesophageal reflux disease (GORD).


METHODS
The RAND Appropriateness Method (RAM) was used to systematically investigate the opinions of an expert panel (6 gastroenterologists and 6 general practitioners) on the appropriateness of either endoscopy or short-term medication for 768 different patient scenarios (cases). Each case was defined by the unique combination of diagnostic characteristics considered to be relevant in treatment choice. Panel members firstly individually rated the appropriateness of all indications using a 9-point scale (9 = extremely appropriate, 1 = extremely inappropriate). Subsequently, the panel discussed the results and re-rated some of the indications. Based on the median score and agreement figures, the individual ratings were converted to panel statements (appropriate, inappropriate, and uncertain) for each of the indications. Logistic regression was used to study the relationship between diagnostic characteristics and panel outcomes.


RESULTS
Disagreement was seen in only 18% of cases. Statistical analysis revealed consistent patterns that determined the panel judgements. The most pronounced patterns and regression results were used to indicate situations in which either medication or referral was considered appropriate by the panel.


CONCLUSIONS
The RAND panel method proved to be useful in the systematic analysis of expert opinion on the appropriate management of symptomatic GORD. Nevertheless, as the recommendations still reflect the subjective opinion of the panel members, their validity and usefulness for daily practice should be the subject of further investigations.
Stoevelaar
H J
HJ
Institute for Health Care Policy & Management (iBMG), Erasmus University Medical Center, PO Box 1738, 3000 DR Rotterdam, The Netherlands. stoevelaar@bmg.eur.nl
McDonnell
J
J
Stals
H
H
Smets
L
L
D032921:Consensus; D003697:Delphi Technique; D016145:Endoscopy, Digestive System / Q000379:methods*; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005762:Gastroenterology / Q000592:standards; D005764:Gastroesophageal Reflux / Q000628:therapy*; D006801:Humans; D011320:Primary Health Care / Q000592:standards*; D054328:Proton Pump Inhibitors
D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors