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

Area of Science:

• Gastroenterology
• Surgical Outreach Programs
• Rural Health Services

Background:

• Diagnostic endoscopy access is limited in rural Western Australia.
• Open access referrals may lead to over-servicing, necessitating adherence to guidelines.
• An outreach surgical service offering open access endoscopy to rural areas was evaluated for utilization.

Purpose of the Study:

• To assess the utilization of an outreach surgical service providing open access endoscopy in rural Western Australia.
• To determine if the service adhered to the American Society for Gastrointestinal Endoscopy (ASGE) guidelines.
• To evaluate the appropriateness of referrals and the frequency of positive pathology.

Main Methods:

• Prospective data collection of upper and lower endoscopy procedures from January 1996 to June 2000.
• Review of referral indications by general practitioners and visiting surgeons for ASGE guideline compliance.
• Analysis of referral appropriateness, positive pathology rates, and reasons for cancelled colonoscopies.

Main Results:

• 772 endoscopies were performed, with 75% as open access services.
• General practitioners made more referrals (583) than visiting surgeons (189).
• Overall compliance with ASGE guidelines was high at 92%, with no significant difference in pathology findings between groups.

Conclusions:

• The outreach rural surgical program in Western Australia offering open access endoscopy aligns with international guidelines.
• The service does not induce unnecessary procedures and benefits rural patients with cost savings and convenience.
• The program reduces government travel costs and decreases waiting lists for procedures.