Aps. Hungin et al., WHAT HAPPENS TO PATIENTS FOLLOWING OPEN ACCESS GASTROSCOPY - AN OUTCOME STUDY FROM GENERAL-PRACTICE, British journal of general practice, 44(388), 1994, pp. 519-521
Background. Open access gastroscopy allows general practitioners to re
quest a gastroscopy without prior referral to a specialist. The effect
of open access gastroscopy upon patient management is poorly explored
. Most studies have been hospital based and have focused on diagnostic
yields and on means of tightening requests to reduce inefficient use.
A user evaluation can only be made by measuring outcomes in primary c
are. Aim. A study was undertaken to determine the impact of open acces
s gastroscopy in general practice and in particular, the value of a no
rmal result. Method. All general practices in South Tees District Heal
th Authority were asked to participate. Any of their patients who had
had open access gastroscopy in the year prior to July 1990 were identi
fied from The hospital computer and their general practitioner notes e
xamined. Patient management during The year prior to the open access g
astroscopy was compared with the year after. The main outcome measures
were: detection rate and grade of lesion, change in graded score of p
rescribed drugs, consultation rate for dyspepsia and non-dyspepsia pro
blems, and further hospital referral and investigations Outcomes among
those with normal and abnormal gastroscopy results were compared. Res
ults. The study sample comprised 715 patients, 36% of whom had a norma
l gastroscopy result, 34% a major abnormality and 26% a minor abnormal
ity (4% of patients had miscellaneous diagnoses). If was found that 39
% of all patients, and 60% of those with normal findings on open acces
s gastroscopy had their drug treatment stopped or reduced in grade aft
er the investigation. Of those with a major endoscopic abnormality 58%
increased their treatment score. Consultations for dyspepsia in the y
ear before and after gastroscopy fell by 57% overall among those with
a normal gastroscopy result, by 37% among those with a minor finding a
nd by 33% in those with a major finding. There was a 21% fall in consu
ltations for all reasons among those with a normal gastroscopy result
but those with a minor abnormality had a 23% increase in non-dyspepsia
consultations. Of all patients 19% were referred to hospital subseque
ntly. Conclusion. Open access gastroscopy has a major effect upon pati
ent management in general practice, and a normal endoscopy result has
as important an impact as an abnormal one. Open access gastroscopy is
associated with a rationalization of drug therapy, reduced consultatio
ns and a low hospital referral rate.