Prevention of overuse: A view on upper gastrointestinal endoscopy

Table 1 Description of studies using a guideline implementation strategy to reduce upper gastrointestinal endoscopies

Study	Country	Sample	Strategy	Effect on UGIE referrals
Cardin et al[18], 2005	Italy	2098 patients	Distribution of a locally adapted international guideline, changing referral criteria.	Reduction: 63% (at first) and 42% (at repeat presentation)
Elwyn et al[20], 2007	United Kingdom	215 PCPh, 359 hospital physicians	Feedback on referrals after distribution of adapted guideline.	Reduction: PCPh 9% (NS), Hospital physicians 31%
Banait et al[21], 2003	United Kingdom	114 PCPr	Educational program, including workshops, hand-outs, and reinforcement visit (intervention), vs passive guideline dissemination (control)	Appropriateness of referrals: Intervention 73%, Control 50%
Shaw et al[22], 2006	United Kingdom	47 PCPr	Promotion of HP testing, serology service, and treatment advice (intervention), vs reserved approach to HP testing	Reduction: Intervention: 27%, Control: 4%

PCPh: Primary care physicians; PCPr: Primary care practices; NS: Non-significant; HP: Helicobacter pylori; UGIE: Upper gastrointestinal endoscopy.