title: Evaluation of the implementation of Galician Health Service indications and priority levels for colonoscopy in symptomatic patients: prospective, cross-sectional study.
abstract: BACKGROUND
  the Galician Health Service established indications and priority levels (I = fast track, II = preferential, III = normal) for colonoscopy, according to the risk of colorectal cancer and significant colonic lesions detection with access from primary health care. Our aim is to show the results of the implementation.
  
  
  METHODS
  we included colonoscopies requested in symptomatic patients from June to October 2012 in a prospective observational cross sectional study. We collected health care level (primary, secondary), priority, appropriateness to the established criteria, wait times (from colonoscopy application and initial consultation) and diagnostic yield for colorectal cancer and/or significant colonic lesion. We compared health care levels in priorities I and II.
  
  
  RESULTS
  425 colonoscopies were included (I = 221, II = 141, III = 63). The appropriateness rate to the protocol was 67.5 %. Priority levels were significantly associated to wait times (days) from application (I = 8.7 ± 8.9, II = 50 + or - 20.3, III = 80.2 + or - 32.2; p < 0.001) and initial consultation (I = 32.2 + or - 38, II = 74.5 + or - 44.2, III = 128.5 + or - 47.4; p < 0.001), and with colorectal cancer (I = 20.1 %, II = 19.1 %, III = 4.8 %, p < 0.001) and significant colonic lesion (I = 35.3 %, II = 34 %, III = 19 %, p = 0.002) detection rates. In priority I and II, 21.8 % of colonoscopies were requested from primary health care. Referral form primary health care reduced wait times from initial consultation to colonoscopy (primary = 29.3 + or - 26, secondary = 55.2 + or - 48.6, p < 0.001). Instead, colorectal cancer (OR 2.41, 95 % CI 1.31-4.42) and significant colonic lesion (OR 1.88, 95 % CI 1.13- 3.15) detection rate was increased.
  
  
  CONCLUSIONS
  Galician Health Service priority levels are significantly associated with colorectal cancer and significant colonic lesion detection. Referrals to colonoscopy from primary health care reduce waiting times and increase diagnostic yield.
authors.forename: Pablo
authors.initials: P
authors.lastname: Vega-Villaamil
authors.forename: María
authors.initials: M
authors.lastname: Salve-Bouzo
authors.forename: Joaquín
authors.initials: J
authors.lastname: Cubiella
authors.forename: Fátima
authors.initials: F
authors.lastname: Valentín-Gómez
authors.forename: Eloy
authors.initials: E
authors.lastname: Sánchez-Hernández
authors.forename: Isabel
authors.initials: I
authors.lastname: Gómez-Fernández
authors.forename: Javier
authors.initials: J
authors.lastname: Fernández-Seara
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000145:classification* / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D005260:Female; D006292:Health Priorities; D006801:Humans; D008297:Male; D011320:Primary Health Care; D011446:Prospective Studies; D013030:Spain