Up to 20-fold geographic variations in rates of gastroscopy and colonoscopy show that more work is needed to enforce adherence to national guidelines and standards, a new report concludes.
Based on new figures, the Australian Commission on Safety and Quality in Health Care is recommending a range of measures to curb inappropriate gastrointestinal procedures including implementation of triage criteria and audits of clinicians performing endoscopy services.
The rates of inappropriate endoscopy revealed in its Australian Atlas of Healthcare Variation have also promoted to Commission to recommend that GESA develop a position statement on the appropriate use and timing of gastroscopy, and of gastroscopy performed with colonoscopy.
In its analysis of endoscopy services, the Atlas focused on use of gastroscopy for younger people for whom there are few indications for its use. It found that in 2018–19 there were 154,338 MBS-subsidised services for gastroscopy for people aged 18–54 years. Rates of gastroscopy varied 11-fold between localities with the highest and lowest use.
Rates of gastroscopy were markedly higher in major cities than elsewhere, and almost two-thirds of services were performed on the same day as a colonoscopy for the same person.
The report also found high rates of early repeat gastroscopy despite there being very few clinical reasons for it within three years.
In 2018–19, there were almost 88,000 MBS-subsidised services for repeat gastroscopy performed within two years and 10 months in people of all ages. The rate in the area with the highest rate was 14.9 times as high as the lowest rate.
The reports recommended that development of national guidance on the appropriate use of gastroscopy should be a priority.
It said guidelines should include recommendations on when gastroscopy should be done at the same time as a colonoscopy. It also recommended that health service organisations conduct audits of clinicians adherence to gastroscopy guidelines, and include the data as part of re-credentialling requirements.
The Atlas also focused on inappropriate use of colonoscopy, finding high rates of repeat colonoscopy within three years of an earlier procedure. It also found that rates were markedly higher in major cities and varied almost 20-fold between high and low use areas.
“More needs to be done to improve the consistent application of the national guidelines on bowel cancer screening and surveillance,” the report stated.
“A concerted focus by clinicians, medical colleges and health service organisations to drive implementation of the Colonoscopy Clinical Care Standard and national guidelines could reduce inappropriate requests for repeat colonoscopies and free up services for people at high risk of bowel cancer.”
The figures from the report would also support ongoing initiatives such as GESA’s Choosing Wisely recommendation on not to repeat colonoscopies more often than recommended by the NHMRC, the Atlas authors said.