title: [Effect of the implementation of a program to improve referrals by primary care on appropriateness and wait times in endoscopic examinations].
abstract: BACKGROUND
  Within a program to improve referrals by primary care (PC) in Ourense (Spain), we implemented practice guidelines on dyspepsia and rectal bleeding. Our aim was to evaluate the reasons for referral to endoscopy, the appropriateness of these referrals, and wait times.
  
  
  METHODS
  We performed a retrospective cohort study in the Ourense health area between February 2009 and January 2010. The endoscopies performed with the indications of dyspepsia and rectal bleeding requested directly from PC were compared with those referred initially to specialist care (SC). The reasons for the referral, the priority of the endoscopy, compliance with the protocol, endoscopic finding and the wait time from referral were gathered.
  
  
  RESULTS
  During the period analyzed, 158 upper gastrointestinal endoscopies (SC: 121; PC: 37) and 243 colonoscopies (SC: 193; PC: 50) were performed with the indications of dyspepsia and rectal bleeding. Among endoscopies, 34.5% and 77.7% were requested with high priority from PC and SC, respectively (p<0.001). The criteria for referral were met in 86.5% of upper gastrointestinal endoscopies and in 82% of colonoscopies requested from PC. No differences were found in endoscopic findings. The median wait time from referral was lower in upper gastrointestinal endoscopy (PC: 105±5.5 days, SC: 174±17.8 days; p: 0.003) and colonoscopies (PC: 101±11.8 days, SC: 187±9.6 days; p<0.001) referred from PC.
  
  
  CONCLUSIONS
  The use of the program for improved referrals by PC reduces wait times. The examinations requested complied with the indications.
authors.affiliation: Servicio de Aparato Digestivo, Complexo Hospitalario de Ourense, Orense, España.
authors.forename: Andrés
authors.initials: A
authors.lastname: Dacal Rivas
authors.forename: Paola
authors.initials: P
authors.lastname: Quintas Lorenzo
authors.forename: María
authors.initials: M
authors.lastname: Francisco González
authors.forename: Joaquín
authors.initials: J
authors.lastname: Cubiella Fernández
authors.forename: María Nieves
authors.initials: MN
authors.lastname: Alonso Docampo
authors.forename: Javier
authors.initials: J
authors.lastname: Fernández Seara
mesh_terms: D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D015331:Cohort Studies; D003113:Colonoscopy / Q000706:statistics & numerical data; D004415:Dyspepsia / Q000175:diagnosis; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data*; D005260:Female; D005762:Gastroenterology / Q000458:organization & administration*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis; D006284:Health Plan Implementation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D012007:Rectum; D012017:Referral and Consultation / Q000458:organization & administration* / Q000706:statistics & numerical data; D012040:Regional Health Planning; D012189:Retrospective Studies; D013030:Spain; D014850:Waiting Lists