title: Implementation and evaluation of early gastroscopy for patients with dyspepsia and warning signs in Primary Care.
abstract: BACKGROUND
  Dyspepsia is a common disorder in both Primary (PC) and Specialised Care (SC). Gastroscopy is recommended at the start of the study if there are warning signs, although it is not always available in PC.
  
  
  OBJECTIVE
  We developed a pilot project establishing an early gastroscopy programme for patients with dyspepsia and warning signs in PC, subsequently extending it to the entire healthcare area. The aim was to evaluate the requirements, impact and opinion of this service at the PC level. Demographic, symptomatic and endoscopic variables on the patients referred to SC from the pilot centre were recorded. A satisfaction survey was conducted among the PC physicians.
  
  
  RESULTS
  The one-year pilot study and the first year of implementation of the programme were evaluated. A total of 355 patients were included (median age 56.4 years; IQR 45.5-64.3); 61.2% (56.1-66.3%) were women. The waiting time for examination was 1.5 weeks (IQR 1.5-2.5). Gastroscopy was correctly indicated in 82.7% (78.4-86.3%) of patients. The median number of requests per month was 1.1 per 10,000 adults (range 0.8-1.6). Monthly referrals to SC clinics from the pilot centre fell by 11 subjects (95% CI 5.9-16) with respect to the previous median of 58 (IQR 48-64.5). Almost all those polled (98.4%) considered the programme useful in routine practice.
  
  
  CONCLUSIONS
  The availability of an early gastroscopy programme in PC for patients with dyspepsia and warning signs reduced the number of referrals to SC.
authors.affiliation: Servicio de Aparato Digestivo, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España. Electronic address: fj.garcia.alonso@gmail.com.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: García-Alonso
authors.affiliation: Servicio de Aparato Digestivo, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España.
authors.forename: María
authors.initials: M
authors.lastname: Hernández Tejero
authors.affiliation: Centro de Salud Francia, Fuenlabrada, Madrid, España.
authors.forename: Elvira
authors.initials: E
authors.lastname: Rubio Benito
authors.affiliation: Servicio de Aparato Digestivo, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España.
authors.forename: Paz
authors.initials: P
authors.lastname: Valer
authors.affiliation: Servicio de Aparato Digestivo, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España.
authors.forename: Iván
authors.initials: I
authors.lastname: Guerra
authors.affiliation: Centro de Salud Francia, Fuenlabrada, Madrid, España.
authors.forename: Victoria Gema
authors.initials: VG
authors.lastname: García Ceballos
authors.affiliation: Centro de Salud Cuzco, Fuenlabrada, Madrid, España.
authors.forename: Mar
authors.initials: M
authors.lastname: Noguerol
authors.affiliation: Centro de Salud El Naranjo, Fuenlabrada, Madrid, España.
authors.forename: Victoria
authors.initials: V
authors.lastname: Llinares
authors.affiliation: Servicio de Aparato Digestivo, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España.
authors.forename: Fernando
authors.initials: F
authors.lastname: Bermejo
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004415:Dyspepsia / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D042241:Early Diagnosis; D004941:Esophagitis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D005756:Gastritis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D005770:Gastrointestinal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D005773:Gastroscopy / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods*; D015397:Program Evaluation; D011446:Prospective Studies; D012307:Risk Factors; D063189:Symptom Assessment; D055815:Young Adult
keywords: Adult; Adulto; Ambulatory care/economics; Ambulatory care/organization & administration; Diagnostic techniques of the digestive system; Dispepsia; Dyspepsia; Endoscopia gastrointestinal; Endoscopy gastrointestinal; Referral and consultation; Remisión y consulta; Servicio ambulatorio en hospital/economía; Servicio ambulatorio en hospital/organización y administración; Técnicas de diagnóstico del sistema digestivo