AN EVALUATION OF PRACTICE AUDIT IN GASTROENTEROLOGY - THE 'PAGE' PROGRAM FOR ENDOSCOPY (EGD)

D Armstrong, ¹R Hollingworth, ²T Vienneau, ³W Smith, RH Hunt, ⁴D Leddin

Division of Gastroenterology, McMaster University, Hamilton, Ontario & ⁴Dalhousie University, Halifax, Nova Scotia; ¹Credit Valley Hospital, Mississauga, Ontario; ²Isis Digital Media, Burlington, Ontario, ³AstraZeneca Canada, Mississauga, Ontario

BACKGROUND: Practice audit is essential for continuing professional education (CPE) but it can be difficult and time-consuming to conduct.
AIMS: To evaluate a novel accredited practice audit program (RCSPC Section 5) for gastroenterologists (GEs) to review specific aspects of their practice and, if desired, compare these with their peers using a hand-held computer (PDA).
METHODS: A questionnaire was developed for GEs to enter data on personal demographics and on consecutive EGDs over a 3-week period using a PDA (Ipaq, Compaq,). PDAs are lent to GEs for data entry before and after each EGD, including indications and findings. On completion, data are downloaded to a central server allowing participating GEs to view their own data, as well as aggregated peer data, anonymously at a password-protected, secure, Canadian Association of Gastroenterology website.
RESULTS: To date (31/10/02), 117 GEs, 12 surgeons and 4 internists have completed the EGD PAGE program with an average of 36, 25 and 27 EGDs each. A high proportion of EGDs were for potential alarm features: age >50yrs (67%), vomiting (13%), anemia/ GI blood loss (26%), dysphagia (17%), weight loss (14%). There was good agreement between expected (E) and reported (R) findings for normal EGD (E:28%, R:31%). However, major findings were less common than expected: esophagitis (E:27%, R:13%), esophageal stricture (E:10%, R:6%), gastric ulcer (E:15%, R:5%), gastric cancer (E:3%, R:1%), duodenal ulcer (E10%, R:6%). At initial evaluation (n=36), 100% of GEs reported the program 'beneficial' and 'easy to use'; 100% requested a program on another topic (incl. colonoscopy 78%, abnormal LFTs 73%, IBD 57%).
CONCLUSIONS: The 'PAGE' program is a convenient, highly acceptable means to provide practice audit on selected topics; it allows GEs to compare practice with their peers and provides 'needs analyses' for further CPE.

Support: CAG and by an unrestricted grant from AstraZeneca Canada.