OPEN ACCESS UPPER GASTROINTESTINAL ENDOSCOPY: FINANCIAL BURDEN OR BENEFIT FOR HOSPITALS?

Abstract

OBJECTIVES: To assess the efficiency of an open access upper gastrointestinal endoscopy (Oesophagogastroduodenoscopy, OGD) service at Taranaki base Hospital, New Zealand by comparing the diagnostic yield of referrals made by hospital-based consultants with those from general practitioners (GPs) to see if GPs were referring more patients with normal examination.
METHODS: For 12 consecutive months, from the 1st of Dec 2013, data
was collected prospectively for all diagnostic OGD’s done at Taranaki
Base Hospital. Analysis of the number of normal OGD’s and the diagnostic yield of abnormal findings from each source of referral (consultant vs GPs) was done using the chi square test.
RESULTS: Out of 829 diagnostic OGD’s, 499 (60.2%) were referred by
hospital-based consultants from all specialities and 330 (39.8%) by GPs.
Anaemia and/or Upper GI bleeding (n=280/829; 33.8%) and dyspepsia (n=254/829; 30.6%) were the common indications for OGD referrals.
Overall 292/829(35.2%) OGDs were normal. OGDs were normal in
91/330 (27.6%) GP-referrals and 201/499 (40.3%) consultant-referrals
(p<0.05). Gastroesophageal reflux disease was the commonest finding
on OGD in 151/330 (45.8%) GP-referrals and 154/499 (30.9%) consultant-referrals. Malignancy was detected in 4/330 (1.2%) GP-referrals and 13 (2.6%) consultant-referrals (p=0.16).
CONCLUSION: We did not find a higher rate of normal OGD’s in
patients referred to Taranaki Base Hospital by the GPs, which goes
against the usual assumption that open access upper gastrointestinal
endoscopy service (utilized by GPs) is a financial burden on a public
funded health system. We think it is an effective way of managing most dyspeptic patients in community.
KEY WORDS: Endoscopy, Gastrointestinal (MeSH), Open access system
(Non-MeSH), Taranaki Base Hospital (Non-MeSH), General Practitioners (MeSH), Referral and Consultation (MeSH), Physicians (MeSH).