UNCENSORED OPEN ACCESS GASTROSCOPY - LIMITED RESOURCES - UNLIMITED DEMAND

In the first 3 yr of an uncensored open access gastroscopy service in a County Hospital, 891 patients attended for first gastroscopy. The da ta on these patients is presented and compared with a randomly selecte d group who attended for gastroscopy in the yr prior to the establishm ent of the service having come to the normal Consultant clinics. In th e open access group the gastroscopy examination was normal in 29 per c ent (32 per cent comparator group), 31 per cent had major abnormalitie s (33 per cent comparator group) and 40 per cent had minor abnormaliti es (35 per cent comparator group). Delay time from referral to endosco py was 37 days for open access patients (45 days comparator group). On ly 6 per cent of open access patients were brought back to O.P.D. (47 per cent comparator group) and 72 per cent of open access patients ret urned directly to their family doctor (28 per cent comparator group). A comparison of the Clonmel findings with British centres reporting th eir results shows a broadly similar picture. It is concluded that almo st 1,300 unnecessary clinic visits were avoided by the provision the o pen access service, some reduction in delay time to gastroscopy was ac hieved,:the family doctor maintained control of patient management in the great majority: of patients, the pattern of referral was not inapp ropriate and compared very well with the comparator group. Over the 3 yr there was a large increase in the number of gastroscopies performed which caused resource difficulties. It is recommended that adequate p lanning of these requirements should be carried out before an open acc ess service is started. At least 1 additional dedicated gastroscopy on ly endoscopy service per week would be required.