Evaluation of a new referral system for the management of dyspepsia in Hong Kong: Role of open-access upper endoscopy

Background: In the management of dyspepsia, upper endoscopy is an important component. In our locality, patients requiring upper endoscopy are convent ionally referred to specialist clinics by family physicians. We have introd uced the first open-access upper endoscopy service in Hong Kong, which has allowed family physicians to arrange endoscopy without prior specialist con sultation. A study on the outcome of open-access upper endoscopy in contras t with the conventional referral system was conducted. Methods: For patients presenting with dyspepsia, family physicians in our r egion were given the option to arrange upper endoscopy directly with our Me dical Endoscopy Unit in addition to the conventional referral to specialist clinics. The results were compared with those from the specialist clinic. A detailed prospective follow up was performed from June to September 1997 to evaluate the outcome and impact of open-access upper endoscopy. Results: From November 1996 to September 1999, 978 referrals for open-acces s upper endoscopy were received. The service significantly reduced the wait ing time for the procedure by 16 weeks. Open-access upper endoscopy had sim ilar detection rates for peptic ulcers and cancers compared with referrals from specialist clinics. Seventy-five percent of patients did not require f urther consultation with their family physicians within 2 months after endo scopy. It is a safe and effective procedure in establishing a definitive di agnosis. All family physicians were satisfied with the open-access upper en doscopy service. Conclusions: This is the first Asian report on this service. Open-access up per endoscopy reduced waiting time from the patient perspective, decreased subsequent consultations with family physicians and reduced referral to spe cialist clinics as well as increased patient and doctor satisfaction. Both referral systems for endoscopy were similar in terms of the diagnostic yiel d. (C) 2000 Blackwell Science Asia Pty Ltd.