Abstract
OBJECTIVE:To determine whether endoscopists and general internistsagreed with the characterization of appropriatenessfor endoscopy of various clinical scenarios, as previouslyreported by the RAND Corporation.DESIGN: Mail survey.STUDY SAMPLE: All endoscopists in western Canadaand a random sample of general internists who did notperform endoscopy.METHODS: Questionnaires were sent to 179 endoscopistsin western Canada who were asked to rate the 53 scenariosfor endoscopy on a nine-point scale ranging from mostappropriate to most inappropriate. A similar questionnairewas sent to 39 general internists practising in theprovince of Alberta.RESULTS: Response rate was 72% of endoscopists(n=128) and 64% of general internists (n=25). Amongthe endoscopists, there was agreement with the RANDclassification for 32 scenarios. All 18 indicationspreviously thought to be appropriate were consideredto be appropriate. However, endoscopists agreed withonly six of 16 equivocal and eight of 19 indicationsconsidered inappropriate. Discrepancies were reviewedby five experienced endoscopists and most appeared tobe related to a concern regarding possible malignancylinked in part with the definition of failure to respondto medical therapy; and to a refusal to request a bariummeal before endoscopy. Among general internists, therewas agreement with RAND in 26 scenarios. When the appropriatenessrankings of endoscopists and general internists werecompared, there was agreement in 40 of 53 scenarios.Significant discrepancies in ratings were identifiedin scenarios in which barium studies were describedas being normal, known or not done.CONCLUSIONS: The equivocal and inappropriateratings developed by the RAND Corporation are not uniformlyaccepted by the endoscopy community or general internists.Use of the RAND indications for assessing quality assurancecan be challenged.