Open access endoscopy in rural and remote Western Australia:Does it work?

摘要

BACKGROUND: Access to diagnostic endoscopy is limited in ruraland remote Western Australia. Published reports suggest open access referralsmay result in over-servicing, this is reduced by adherence to theAmerican Society for Gastrointestinal Endoscopy (ASGE) guidelines.The aim was to assess whether an outreach surgical service offeringopen access endoscopy to rural areas was being over utilized. METHODS: Prospective data collection from all patients undergoingupper and lower endoscopy procedures between January 1996 and June2000 were included in the present study. Indications for referralbetween the general practitioners and the visiting surgeons werereviewed in patient records and assessed for compliance with theASGE guidelines. The groups were analysed for appropriateness ofreferrals and frequency of positive pathology investigations. Recordsfor all patients undergoing colonoscopy were reviewed to determinethe reason and number of cancelled procedures. RESULTS: A total of 772 endoscopies were performed and 75% werebooked as open access services. The referral rate for procedures wasgreater for general practitioners (583) compared to the visitingsurgeons (189), the overall compliance rate for approved indicationsusing the ASGE guidelines for both groups was 92%. Therewas no significant difference in pathology found between groups. CONCLUSION: The present study shows that an outreach rural surgicalservice programme in Western Australia offering open access endoscopyconforms to international guidelines and does not induce unnecessaryprocedures. Rural patients benefit from a personal cost savings andconvenience. There is an associated reduction in government-assistedtravel costs to larger centres as well as decreased waiting lists.