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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Health Services Research 1/2018

Gastroenterologist and primary care perspectives on a post-endoscopy discharge policy: impact on clinic wait times, provider satisfaction and provider workload

Zeitschrift:
BMC Health Services Research > Ausgabe 1/2018
Autoren:
Daniel Selvig, Justin L. Sewell, Delphine S. Tuot, Lukejohn W. Day
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12913-017-2819-6) contains supplementary material, which is available to authorized users.

Abstract

Background

To reduce unnecessary ambulatory gastroenterology (GI) visits and increase access to GI care, San Francisco Health Network gastroenterologists and primary care providers implemented guidelines in 2013 that discharged certain patients back to primary care after endoscopy with formal written recommendations. This study assesses the longer-term impact of this policy on GI clinic access, workflow, and provider satisfaction.

Methods

An email-based survey assessed gastroenterologist and primary care provider (PCP) opinions about the discharge process. Administrative data and chart review were used to assess clinic access, intervention fidelity, and re-referral rates.

Results

102/299 (34%) of PCPs and 5/7 (71%) of gastroenterologists responded to the survey. 74% of PCPs and 100% of gastroenterologists were satisfied or very satisfied with the discharge process. 80% of gastroenterologists believed the discharge process decreased their workload, while 53.5% of primary care providers believed it increased their workload. 6.7% of patients discharged to primary care in 2013 had re-referrals to GI. Wait time for the third-next-available new outpatient GI clinic appointment had previously decreased from 158 days (2012, pre-intervention) to 74 days (2013, post-intervention). In 2015, wait time was 19 days (p < 0.001 for 2012 vs. 2015).

Conclusions

Primary care providers and gastroenterologists are satisfied with an intervention to discharge patients from gastroenterology to primary care after certain endoscopic procedures, although this conclusion is limited by a relatively low PCP survey response rate. Discharging appropriate patients using consensus criteria from the gastroenterology clinic was instrumental in sustainably reducing clinic wait times with low re-referral rates.
Zusatzmaterial
Additional file 1: Discharge Criteria.pdf (Title: Post-Endoscopy Discharge Criteria from GI Clinic Back to Primary Care.) (PDF 119 kb)
12913_2017_2819_MOESM1_ESM.pdf
Additional file 2: PCP Survey.pdf (Survey administered to primary care providers). (PDF 56 kb)
12913_2017_2819_MOESM2_ESM.pdf
Additional file 3: Gastroenterologist Survey.pdf (Survey administered to gastroenterologists). (PDF 54 kb)
12913_2017_2819_MOESM3_ESM.pdf
Literatur
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